Abstract:
A pocket orthodontic bonding pad for attaching orthodontic attachments to teeth wherein the orthodontic attachment is mechanically secured within a bonding pad pocket with a design that allows a slight buffering flexibility under masticatory stress and ease of removal of the orthodontic attachment. Upon removal of locking tabs the orthodontic attachment may be removed with minimal force, and the remaining bonding pad polished from the teeth with ease, which is most advantageous for brackets that tend to break upon removal and create high stress forces upon tooth structure. The ease of removing orthodontic attachments allows maximum bonding strengths.

Description:
[0001]    This application claims the benefit of U.S. Provisional Application No. 62/011,423, filed Jun. 12, 2014. The disclosure of this prior application is incorporated herein by reference in its entirety for all purposes. 
     
    
       [0002]    This invention relates in general to a polymer/plastic pocket orthodontic bonding pad for orthodontic attachments, mainly brackets. The pocket orthodontic bonding pad removably receives the orthodontic attachment which is locked into the pocket. Upon removal of the lock, the orthodontic attachment is removed with minimal pressure. This is particularly advantageous for orthodontic brackets, which tend to break upon removal. The pocket orthodontic bonding pad imparts a slight degree of flexibility to the orthodontic attachment, which buffers against masticatory forces. The pocket orthodontic bonding pad further allows maximum-strength bonding materials bonded to the tooth, wherein the bonding pad is designed to be the breakaway force determinant for the orthodontic attachment, this force being less than the force being necessary to break tooth enamel from a tooth. This is particularly advantageous because direct bracket/enamel bonds universally create microfractures in enamel when removed or debonded from teeth. 
       BACKGROUND OF THE INVENTION 
       [0003]    With the development of the ability to bond material to teeth, more particularly to tooth enamel, orthodontics was presented with bondable brackets and attachments. The strength of the bracket bond to a tooth was determined by the combination of the strength of the bond to the tooth, the strength of the bonding material, and the strength of the bond to the orthodontic attachment. The bond to the orthodontic bracket was facilitated by using bonding materials, such as acrylics, which readily formed a strong union with the bracket. Metal brackets and other attachments were developed with a mesh-type bonding surface that produced a semi-mechanical lock with the bonding material. Plastic brackets were easily broken and absorbed stains. Ceramic brackets were then developed. 
         [0004]    Ceramic brackets, as described in U.S. Pat. No. 4,948,366, were made from mono-crystalline or poly-crystalline aluminum oxide, which were resistant to staining. The bonding surface of the ceramic bracket was treated with a silane coupling agent in order to enhance the strength of the bond with the bonding material. The ceramic material was similar to a diamond, hard and brittle, resulting in a surface hardness greater than that of tooth enamel. If the ceramic bracket had an occlusal interference it would abrade the enamel of the opposing teeth. The orthodontic company rushed to market with this new product by advertising directly to the public, which created a public demand for the product before adequate clinical trials had been performed. Clinically, the orthodontist found that when attempting to remove the ceramic bracket from a patient&#39;s tooth, the tooth enamel would occasionally detach with the ceramic bracket. The strength of the ceramic bracket to enamel bond was greater than the enamel to the underlying tooth. Research revealed that the smooth bonding surface of the ceramic bracket treated with a silane-coupler greatly enhanced the attachment of the bonding material to the ceramic bracket. It was also found that this type of flat surface on the ceramic bracket produced a very thin layer of bonding film, which in turn produced a stronger bond. The thinner the bonding film the stronger the bond. 
         [0005]    Ceramic brackets are often removed with the jaws of an orthodontic pin cutter by placing the cutting edges between the bracket base and the tooth and squeezing. The orthodontic ceramic bracket would often fracture upon attempted removal from the tooth, leaving a piece of the ceramic bracket still bonded to the tooth. At this point a dental drill would often have to be used to remove the piece of ceramic bracket from the tooth. The dental drill was not a perfect solution due to the nature of the hardness of the porcelain bracket. The dental drill most commonly used was diamond-coated, which had close to the same hardness as the porcelain bracket, and which was harder than tooth enamel. The ceramic bracket was also the same color as tooth enamel. Thus, tooth enamel could be inadvertently removed. 
         [0006]    The mesh-backed metal brackets were more successful than the ceramic bracket. The mesh-backed metal bracket produced a greater thickness of bonding material, allowing enough space between the bracket and the tooth to allow the pin cutter to more easily wedge between the bracket and tooth and remove the bracket when the pin cutter jaws were squeezed together. The metal brackets would not fracture as the porcelain brackets did. The early metal brackets also had the ability to flex, wherein twin brackets could be gripped and squeezed by a pair of pliers, which broke the bond. Modernly, metal brackets are formed by metal injection molding and do not possess this flexing ability yet still will remain in one piece during removal. 
         [0007]    Several attempts have been made to solve the debonding problem associated with ceramic brackets. For example, it was proposed in U.S. Pat. No. 4,455,138 that applying heat to the dental bracket would assist in loosening the adhesive bonding of the bracket to the tooth so that the ceramic bracket may be more easily removed with less force. It was found that this system was not always practical as the orthodontist may prematurely pull the bracket in anticipation of the loosening of adhesive, causing great pain to the patient and also shattering the bracket before the heat applied would loosen the adhesive. Further, the pulling force could not be directionally controlled with this system. In addition, the high temperatures associated with this method of removal could cause pulpal or nerve damage to the tooth. 
         [0008]    Another debracketing tool and method of removal is disclosed in U.S. Pat. No. 4,907,965, where the heat and debracketing force is simultaneously applied. This system does not always assure that the adhesive is sufficiently loose to allow easy removal, and likewise requires engagement of the ceramic bracket during removal. In addition, the high temperatures associated with this method of removal could cause pulpal or nerve damage to the tooth. 
         [0009]    A relatively flexible bonding pad is described in U.S. Pat. No. 5,098,288, wherein a bonding pad is secured to the bracket and bonded to the surface of a tooth. The attached pad is gripped by pliers, causing a buckling of the pad, breaking the bond between the pad and the tooth. The purpose was to prevent fracturing of the bracket during the removal process. However, the flexibility of the bonding pad does not allow for higher bonding strengths between the bonding pad and the enamel surface. In fact, increasing bonding strengths between the bonding pad and the enamel surface decreases flexibility of the bonding pad. 
         [0010]    U.S. Pat. No. 5,263,859 describes a flexible bonding pad with holes, allowing the bonding material to come in direct contact with the bracket. The purpose was to increase the strength of the bond to the bracket. However, the flexibility of the bonding pad does not allow for efficient bonding strengths between the bonding pad and the enamel surface. In fact, increasing bonding strengths between the bonding pad and the enamel surface decreases flexibility of the bonding pad. 
         [0011]    U.S. Pat. No. 6,786,720 discloses a light-curable methacrylate-based epoxy resin bonding pad molded to a ceramic orthodontic appliance. Debonding is performed by squeezing the pad with ligature cutters, causing the bracket to release from the tooth. However, the flexibility of the bonding pad does not allow for efficient bonding strengths between the bonding pad and the enamel surface. In fact, increasing bonding strengths between the bonding pad and the enamel surface decreases flexibility of the bonding pad. 
         [0012]    Another factor involving orthodontic brackets is the unintentional debonding during the patient&#39;s treatment which is time-consuming for the orthodontist, and often delays the completion of the patient&#39;s treatment. Most commonly, the patient has eaten something too hard. Orthodontics is moving toward digitally-assisted bracket placement. If one failure occurs in treatment, it is virtually impossible to replace the bracket in the same position. With the trend in extended appointment intervals (from traditional 4-week intervals to current 8-10-week intervals), a broken bracket can greatly add additional treatment time and significant cost to the orthodontist due to the process involved to repair the unintentionally broken bond. The dilemma is that orthodontic bond strengths must be strong enough to adhere brackets to teeth yet weak enough that upon removal they do not fracture enamel, causing damage to the teeth. Further, the pulling force could not be directionally controlled with this system. 
         [0013]    U.S. Pat. No. 7,819,660 discloses appliances that are not designed to resist or distribute masticatory shear forces of an occlusal gingival direction. The appliances rely on an expensive multitude of bracket bodies with different x-axis, y-axis, and z-axis positions. 
         [0014]    Another debracketing tool and method of removal is disclosed in U.S. Pat. No. 4,907,965, wherein heat and debracketing force is simultaneously applied. This system does not always assure that the adhesive is sufficiently loose to allow easy removal, and likewise requires engagement of the ceramic bracket during removal. In addition, the high temperatures associated with this method of removal could cause pulpal or nerve damage to the tooth. 
         [0015]    It is also known to provide a relatively flexible bonding pad or base for an orthodontic bracket to facilitate debonding, as disclosed in U.S. Pat. No. 5,098,288. However, it has been found that the bonding between the pad and the bracket often fails during treatment due to the various forces on the bracket during treatment, thereby necessitating re-bonding. Further, the flexibility of the bonding pad does not allow for efficient bonding strengths between the bonding pad and the enamel surface. In fact, increasing bonding strengths between the bonding pad and the enamel surface decreases flexibility of the bonding pad. In such instances, treatment has been interrupted, delaying the ultimate conclusion of treatment, and costly chair time is required to re-bond the bracket to the tooth. 
       SUMMARY OF THE INVENTION 
       [0016]    Orthodontics is moving toward digitally-assisted bracket placement. If one failure occurs in treatment, it is virtually impossible to replace the bracket in the same position. With the trend in extended appointment intervals (from traditional 4-week intervals to current 8-10-week intervals) a broken bracket can greatly add additional treatment time. The dilemma is that orthodontic bond strengths must be strong enough to adhere brackets to teeth yet weak enough that upon removal they do not fracture enamel or damage teeth. 
         [0017]    Tavas and Watts reported that shear/peel strengths of bonded adhesives should develop 3.9 to 5.9 MPa. While this relatively weak bond strength ensures easy removal of brackets, it also leaves the patient very susceptible to broken brackets through normal masticatory forces or not adhering to a brace-friendly diet. Literature reports bond strengths to 15 MPa with orthodontic adhesives. Enamel bond strengths of up to 38.3 MPa are currently possible with modern dental materials and it would follow that higher bond strengths will continue to evolve as time goes on. By increasing bond strengths, orthodontic appliances need not rely on surface area for bond strength, permitting orthodontic appliances to be much smaller. Smaller orthodontic appliances are particularly advantageous to dental aesthetics, comfort, and access for hygiene. 
         [0018]    Brackets tend to debond through masticatory shear forces in an occlusal gingival direction. Therefore, a bracket that is resistant to this force vector and shock-absorbing to this force vector would be desired. Slight flexibility of the bonding pad tends to mitigate the effects of these shear forces. Current debonding techniques require the orthodontist to remove adhesive remnants from the teeth using a fine fluted finishing bur. Most adhesive remains on the teeth, so it is normal protocol and procedure that this removal process is common. The bonding pads of the present invention and adhesive can be limitless in mechanical and chemical adhesion to teeth, while negating debonding forces to remove bonding pads from teeth. Further, the bonding pads of the present invention are thin and easily destructible, further providing for easy removal. 
         [0019]    The concept of the bonding pad is to (1) enable very high bond strength at the pad-enamel interface (chemical/etch retention) through a polymer/plastic bonding pad that is mechanically attached to the attachment body; (2) enable the orthodontist to remove attachments at very low forces due to the unique design of the bonding pad/attachment interface, such that with a simple adjustment to the bonding pad, mechanical retention of the orthodontic attachment body to the bonding pad is reduced from high strength to near zero; and (3) design the bonding pad/attachment to allow shock absorption to distribute masticatory force. The occlusal-gingival, mesial-distal, and lingual-labial positions are made within the bonding pad&#39;s shape, but permit the use of a singular, standard attachment body, which tends to be the expensive and intricate component, especially with the advent of self-ligating orthodontic brackets that have multiple moving parts. The bonding pads are particularly suited to be individually fabricated, preferably specifically to the anatomy of each tooth of a patient, preferably specifically to the occlusal-gingival, mesial-distal, and lingual-labial positions on each tooth of a patient, and preferably printed by a three-dimensional printer. 
         [0020]    The present invention enables the orthodontist to lower the forces at the debond appointment by a simple manipulation of the amount of mechanical retention of the orthodontic attachment to the bonding pad. A metal, ceramic, or polymer orthodontic attachment with a smooth base surface can be preferably shaped such that the gingival side is optionally narrow and tapers to a wider occlusal side. Alternatively, the metal, ceramic, or polymer orthodontic attachment with a smooth base surface can be preferably shaped such that the occlusal side is optionally narrow and tapers to a wider gingival side. In alternative embodiments, either of the left and right sides may be optionally narrow and tapered relative to the other. This preferable tapering ensures an easy path of draw in an occlusal direction. Optional, preferable occlusal or gingival tapering also ensures resistance from an occlusal-gingival direction. The orthodontic attachment is enveloped mechanically in the bonding pad. The bonding pad can optionally be made out of a plastic or polymer that is similar to the bonding adhesives. Further, the bracket cannot be removed from the bonding pad unless the pad is destroyed by removal of locking features, thus creating an irreversible assembly for a more solid structure. This is particularly advantageous because reusable orthodontic bracket assemblies must balance the strength of bonding that permits bracket assembly removal and subsequent reattachment to a patient&#39;s tooth with the strength of bonding that prevents accidental dislodgement. The bonding pad of the present invention does not rely on flexibility to debond the attachment; instead, a rotary instrument is used to polish. Further, addition of an orthodontic attachment to the bonding pad adds rigidity to the bonding pad by acting as an underlying framework to support the bonding pad. The polymer mesh could optionally be impregnated with an anti-cariogenic or naturally occurring molecule with the ability to release calcium and phosphate ions, stabilize, and/or mitigate the common occurrence of enamel decalcification that is common around orthodontic bonding pads, such as fluoride, selenium, calcium, casein phosphopeptide (“CPP”), or amorphous calcium phosphate (“ACP”). 
         [0021]    During debonding of the present invention, no shear forces or compressive forces need be applied to the interface between the bonding pad and tooth enamel. Instead, the mechanical tab securing the orthodontic attachment or in the retentive aspects of the bonding pad is removed or polished away. Subsequently, a pliers or debonding tool engages the orthodontic attachment and lifts the attachment out of the pocket of the bonding pad in a gingival to occlusal direction. This debonding procedure eliminates the need to apply a prying or pulling force directly to the interface between the enamel and the bonding pad or orthodontic attachment, mitigating the enamel microfracture damage that occurs to tooth enamel during the typical debonding process. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0022]      FIG. 1A  is a perspective view of the pocket orthodontic bonding pad. 
           [0023]      FIG. 1B  is a perspective view of the pocket orthodontic bonding pad with the upper part hinged open. 
           [0024]      FIG. 2  is a perspective view of an orthodontic attachment with a female receptacle in the base. 
           [0025]      FIG. 3  is a frontal view of the orthodontic attachment stem wherein the base is locked within the pocket orthodontic bonding pad with protruding surfaces and a central protruding surface; 
           [0026]      FIG. 4  is a cross-section of  FIG. 3  through D-D showing a cross-section of the orthodontic bracket; 
           [0027]      FIG. 5  is a cross-section of  FIG. 3  through C-C. 
           [0028]      FIG. 6  is a frontal view of the orthodontic attachment stem wherein the base is locked within the pocket orthodontic bonding pad with protruding surfaces. 
           [0029]      FIG. 7  is a cross-section of  FIG. 6  through E-E showing a cross-section of the orthodontic attachment. 
           [0030]      FIG. 8  is a perspective view of the pad wherein the attachment-containing pad is attached to a tooth and a dental drill is used to remove the protruding surfaces. 
           [0031]      FIG. 9  is a perspective view showing an orthodontic band remover removing the orthodontic attachment from the bonding pad. 
           [0032]      FIG. 10  is a perspective view showing a dental handpiece with a grinding stone removing the bonding pad from the surface of the tooth. 
           [0033]      FIG. 11  is a rear view of an orthodontic attachment embodiment with a relief channel. 
           [0034]      FIG. 12  is a perspective view of the orthodontic attachment shown in  FIG. 11 . 
           [0035]      FIG. 13  is a perspective view of the orthodontic attachment with a relief channel with mesial-distal pressure exerted such that the bracket is compressed inward into the relief channel. 
           [0036]      FIG. 14  is a top cross-section view of an orthodontic attachment with a relief channel reversibly received into a pocket orthodontic bonding pad with a spine. 
           [0037]      FIG. 15  is a top cross-section view showing application of mesial-distal pressure to an orthodontic attachment with a relief channel reversibly received into a pocket orthodontic bonding pad with a spine. 
           [0038]      FIG. 16  is a perspective view of an alternative embodiment of an orthodontic bonding pad attached to a tooth. 
           [0039]      FIG. 17A  is a perspective view of an orthodontic attachment that has reversibly received the orthodontic bonding pad of  FIG. 16 . 
           [0040]      FIG. 17B  is a perspective view showing a dental drill removing a protruding surface from the orthodontic bonding pad in  FIG. 17A . 
           [0041]      FIG. 17C  is a perspective view showing an orthodontic band remover removing the orthodontic attachment from the bonding pad in  FIG. 17A . 
           [0042]      FIG. 17D  is a perspective view showing the bonding pad of  FIG. 17A  after the protruding surface has been removed and the orthodontic attachment lifted off. 
           [0043]      FIG. 17E  shows showing a dental handpiece with a grinding stone removing the bonding pad of  FIG. 17D  from the surface of the tooth. 
           [0044]      FIG. 18A  is an occlusal-gingival cross-section of an alternative embodiment of an orthodontic bonding pad with a living hinge that has been reversibly received by an orthodontic attachment. 
           [0045]      FIG. 18B  is an occlusal-gingival cross-section showing the movement of the orthodontic bonding pad of  FIG. 18A  when open, the bonding surface of the orthodontic bonding pad not bonded to the enamel of a tooth. 
           [0046]      FIG. 18C  is a mesial-distal cross-section of the orthodontic attachment in  FIG. 18A  that has reversibly received the orthodontic bonding pad. 
           [0047]      FIG. 19  is a perspective view showing an alternative embodiment of an orthodontic bonding pad with a living hinge on the bonding surface. 
           [0048]      FIG. 20  is a perspective view of an orthodontic attachment that has reversibly received the orthodontic bonding pad of  FIG. 19 . 
           [0049]      FIG. 21  is a lingual-labial cross-section of an alternative embodiment of an orthodontic bonding pad that has received an orthodontic attachment. 
           [0050]      FIG. 22  shows a single tooth of a replica of an individual patient&#39;s tooth. 
           [0051]      FIG. 23  is a perspective view of the single tooth shown in  FIG. 22 . 
           [0052]      FIG. 24  is a back view of an embodiment of an orthodontic bonding pad that has received an orthodontic attachment. 
           [0053]      FIG. 25  is a back view of an alternative embodiment of the orthodontic bonding pad shown in  FIG. 24 . 
           [0054]      FIG. 26  is a perspective view of an alternative embodiment of the tooth shown in  FIG. 23 . 
           [0055]      FIG. 27  is a perspective view of an embodiment of an orthodontic bonding pad with an occlusal index attached. 
           [0056]      FIG. 28  is a frontal view of a tooth of a patient with the orthodontic bonding pad of  FIG. 27  that has reversibly received an orthodontic attachment. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0057]    The present invention relates to an orthodontic attachment bonding pad that contains retentive aspects that receive an orthodontic attachment and has a bonding surface that bonds to a tooth. The design of the pocket is to allow the removal of the attachment with minimal pressure. The pocket orthodontic bonding pad is comprised of a polymer/plastic material that is comprised of a highly bondable material that is of a hardness such that it can be easily removed from a tooth with a dental drill. The material and the design of the pocket orthodontic bonding pad are intended to produce a shock absorbing effect. The x-, y-, and z-directional axes are subsequently referred to and claimed by reference to mesial-distal, occlusal-gingival, and lingual-labial axes for relation to human anatomical dimensions, without respect to corresponding axes; no representation is made, for example, that the x-axis need be limited to specifically correspond to one of mesial-distal, occlusal-gingival, or lingual-labial over either of the others two. Additionally, “torque” refers to the rotation of a tooth on its long axis, especially the movement of the apical portions of the teeth by use of orthodontic appliances. “Angulation” refers to the deviation of a tooth from a straight line, i.e. an occlusal-gingival axis. “Tipping” refers to forcibly pivoting a tooth so that its crown is moved labially or lingually. 
         [0058]      FIG. 1A  shows an embodiment of the pocket orthodontic bonding pad  1  with retentive aspects consisting of an internal pocket  2  defined by optionally tapered sides  3  and a top occlusal side  4  and lower gingival side  5 . The top occlusal side  4  partially or fully encloses the internal pocket  2  with one or more locking tabs  6   a.    
         [0059]      FIG. 1B  an embodiment of the pocket orthodontic bonding pad  1  wherein the back of the pad  15  is tipped to open at the top occlusal side  4  of the internal pocket  2 , hinged by the living hinge  6   b . The top occlusal side  4  faces the chewing surfaces of the teeth. The top occlusal side  4  also contains a male surface  6   c  that protrudes into the internal pocket  2  area. Once the pocket orthodontic bonding pad  1  is closed and is bonded to the enamel surface of a patient&#39;s tooth, the living hinge  6   b  is irreversibly closed over an orthodontic attachment due to the contact with the enamel surface of a patient&#39;s tooth, and the orthodontic attachment is retained in the internal pocket  2  until the male surface  6   c  or top occlusal side  4  is removed. Brackets tend to debond from masticatory shear forces from the occlusal direction because there is no shock-absorbing effect to the enamel/bonding pad interface. 
         [0060]      FIG. 2  shows an embodiment of an orthodontic attachment  6   e  with a stem  7  attached to a base  8 . The base  8  has a bottom gingival side,  9 , an upper occlusal side  11 , and left and right sides  12 . The left and right sides  12  may optionally be tapered, and widen towards the upper occlusal side  11 . Alternatively, the left and right sides  12  may optionally be tapered, and widen towards the bottom gingival side  9 . The orthodontic attachment  6   e  of  FIG. 2  inserts within the internal pocket  2  of  FIG. 1A  wherein A 1  aligns with A 2  and B 1  aligns with B 2 . 
         [0061]      FIG. 3  shows the base  8  within the internal pocket  2 , the stem  7  centrally, and the male surface  6   c  seated within the female receptacle  6   d . The male surface  6   c  and female receptacle  6   d  are optional features and neither the pocket orthodontic bonding pads nor orthodontic attachments of the present invention are limited to embodiments including a male surface  6   c  and/or female receptacle  6   d.    
         [0062]      FIG. 4  shows a cross-section through D-D of  FIG. 3 . A male surface  6   c  locks the base  8 . The bonding surface  13  of the pocket orthodontic bonding pad  1  is irregular, which enhances the strength of the bond. Because the pocket orthodontic bonding pad  1  is not forcibly removed from a tooth, but instead polished off of a tooth, the irregularity of the bonding surface  13  is limitless, thus enhancing the mechanical retention of the adhesive to the bonding pad. 
         [0063]      FIG. 5  is a cross-section of  FIG. 3  through C-C. The top occlusal side  4  of the pocket orthodontic bonding pad  1  wherein the locking tabs  6   a  enclose the base  8 . The front side  16  of the pocket orthodontic bonding pad  1  completes the enclosure of the base  8 . It is desirable that the pocket orthodontic bonding pad  1  have a shock-absorbing effect in order to resist the chewing forces. The shock-absorbing effect is determined by the material and the design of the pocket orthodontic bonding pad  1 . The break-away release force of the orthodontic attachment  6   e  is the force required to dislodge the orthodontic attachment  6   e  from the pocket orthodontic bonding pad  1 . The break-away force is determined by the locking tabs  6   a  or top occlusal side  4 , the optional male surface  6   c  engaging the optional female receptacle  6   d  or upper occlusal side  11  of the base  8 , and the front of the pocket orthodontic bonding pad  1 . It is important that the break-away force to intentionally release the attachment from the bonding pad is less than the force to remove enamel from a tooth. The ability to keep the orthodontic attachment  6   e  on a tooth is only compromised when the locking tabs  6   a , top occlusal side  4 , or male surface  6   c  is removed. Conversely, it is important that the retention force be great enough to retain the orthodontic attachment  6   e  for the duration of the treatment. Besides being time-consuming to replace an orthodontic attachment  6   e , modern orthodontics is turning to computer-positioned attachments and 8-10 week appointment intervals, where it is virtually impossible to replace an attachment in its original computer-selected position. 
         [0064]      FIG. 6  discloses another embodiment wherein the pocket orthodontic bonding pad  1  has a tab  17  at the top occlusal side  4  that encloses the base  8  as shown in  FIG. 7 . 
         [0065]      FIG. 7  shows a cross-section of  FIG. 6  through E-E wherein the occlusal portion of the base  8  is enclosed by the tab  17 . 
         [0066]      FIG. 8  discloses the pocket orthodontic bonding pad  1  bonded to a tooth  20  with the tooth occlusal  21  facing upwards and the pocket orthodontic bonding pad  1  upper occlusal side  11  facing upwards. A dental drill  22  attached to a dental handpiece  23  is used to remove the locking tabs  6   a  and the male surface  6   c . The orthodontic attachment  6   e  is now open to the upper occlusal side  11 . The optionally tapered sides  3  and left and right sides  12 , as shown in  FIGS. 1 ,  2 ,  3 , and  6 , further facilitate the removal in an occlusal  21  direction with minimal pressure. The orthodontic attachment  6   e  may be removed without breakage to the orthodontic attachment  6   e  or tooth  20 . This is particularly advantageous for removing attachments, which are prone to breakage during removal. Pieces of a broken bracket left on a tooth frequently have to be ground off, using very aggressive cutting instruments and/or diamonds, which is difficult due to hardness of the material. The grinding process with these aggressive cutting instruments and/or diamonds may also inadvertently remove underlying tooth  20  enamel. 
         [0067]      FIG. 9  shows an orthodontic band-removing pliers  24  used to remove the orthodontic attachment  6   e  from the pocket orthodontic bonding pad  1  in an occlusal  21  direction. This removal requires minimal pressure, which is comfortable for the patient and does not run the risk of breaking the orthodontic attachment  6   e . The lack of breakage of the orthodontic attachment  6   e  is especially advantageous as brackets are very prone to breakage during removal. 
         [0068]      FIG. 10  shows a dental handpiece  23  with a polisher  22  removing the remainder of the pocket orthodontic bonding pad  1  from the tooth  20 . The pocket orthodontic bonding pad  1  is comprised of a material softer than tooth enamel, which allows easy removal. The pocket orthodontic bonding pad  1  is comprised of a polymer or acrylic, which is firm enough to retain the orthodontic attachment  6   e , flexible enough to allow some flexion of the orthodontic attachment  6   e  within the pocket orthodontic bonding pad  1 , and soft enough to allow the pocket orthodontic bonding pad  1  to be easily polished off the tooth  20  as shown in  FIG. 10 . 
         [0069]      FIG. 11  shows the rear view of an orthodontic attachment  6   f  with a stem  26  attached to a base  25  with an upper occlusal side  25   a  and a lower gingival side  25   b . The base  25  is bifurcated along the occlusal-gingival axis, with a relief channel  6   g  between the halves of the bracket base  25 , and extending into the stem  26 , as seen in  FIG. 12 . The base  25  has a smooth outer surface  27 . 
         [0070]      FIG. 13  is a perspective view of the orthodontic attachment  6   f  with mesial-distal pressure  28  applied such that the halves of base  25  are compressed inward into the relief channel  6   g . The compression allows the orthodontic attachment  6   f  to be removed from a pocket orthodontic bonding pad with minimal pressure, by removing the periphery of the base from the retentive aspects of the bonding pad. 
         [0071]      FIG. 14  is a top-cross-section view of an orthodontic attachment  6   f  with a relief channel  6   g  reversibly received into a pocket orthodontic bonding pad  30  with a spine  29  and internal pocket  31 . The bifurcated halves of the bracket base  25  flank the sides of the spine  29 . The spine  29  is an optional feature of pocket orthodontic bonding pad  30  and is by no means intended to limit the presently claimed inventions to the currently described embodiment. 
         [0072]      FIG. 15  shows the application of mesial-distal pressure to an orthodontic attachment  6   f  reversibly with a relief channel  6   g  reversibly received into a pocket orthodontic bonding pad  30  with a spine  29 . The spine  29  diverts the compressed halves of the base  25  outward away from the pocket orthodontic bonding pad  30 , allowing the orthodontic attachment  6   f  to be removed with minimal pressure. The spine  29  is an optional feature of pocket orthodontic bonding pad  30  and is by no means intended to limit the presently claimed inventions to the currently described embodiment. 
         [0073]      FIG. 16  is a perspective view of an embodiment of an orthodontic bonding pad  31  bonded to a tooth  20 . The orthodontic bonding pad  31  has a top occlusal side  35  and a bottom gingival side  36 . The stem  32  is in the shape of a female depression attached to the front of the bonding pad base  39 . The head  33  is attached to the end of the stem  32  opposite that attached to the base  39 . A protruding surface  34  is attached centrally on the top occlusal side, preferably flush with the bonding surface, and can lock an orthodontic attachment received by the orthodontic bonding pad  31  in place until the protruding surface  34  is removed. 
         [0074]      FIG. 17A  is a perspective view of an embodiment of an orthodontic attachment  37  that has reversibly received the head  33  of the orthodontic bonding pad  31  shown in  FIG. 16 . The orthodontic attachment has a top occlusal side  38  that is locked in receiving position by protruding surface  34 . The orthodontic attachment  37  cannot be removed from the orthodontic bonding pad  31  until the male tab  34  on the orthodontic bonding pad  31  has been removed.  FIG. 17B  shows a dental handpiece  23  with a drill  22  removing the protruding surface  34  from orthodontic bonding pad  31 . The orthodontic attachment  6   e  may be removed without breakage to the orthodontic attachment  37  or tooth  20 . This is particularly advantageous for removing attachments, which are prone to breakage during removal. Pieces of a broken bracket left on a tooth frequently have to be ground off, using very aggressive cutting instruments and/or diamonds, which is difficult due to hardness of the material. The grinding process, using very aggressive cutting instruments and/or diamonds, may also inadvertently remove underlying tooth  20  enamel. 
         [0075]      FIG. 17C  shows an orthodontic band-removing pliers  24  used to remove the orthodontic attachment  37  from the pocket orthodontic bonding pad  31  in an occlusal direction. This removal requires minimal pressure, which is comfortable for the patient and does not run the risk of breaking the orthodontic attachment  37 . The lack of breakage of the orthodontic attachment  37  is especially advantageous as brackets are very prone to breakage during removal.  FIG. 17D  shows the orthodontic bonding pad  31  after the orthodontic attachment  37  has been removed. The protruding surface  34  in  FIG. 16  had to be removed in order to remove the orthodontic attachment  37 .  FIG. 17E  shows a dental handpiece  23  with a polisher  22   a  removing the remainder of the orthodontic bonding pad  31  from the tooth  20 . The pocket orthodontic bonding pad  31  is comprised of a material softer than tooth enamel, which allows easy removal. The orthodontic bonding pad  31  is comprised of a polymer or acrylic, which is firm enough to be locked in the orthodontic attachment  37 , flexible enough to allow some flexion of the orthodontic attachment  37  around the orthodontic bonding pad  31 , and soft enough to allow the orthodontic bonding pad  31  to be easily polished off the tooth  20 . The orthodontic bonding pad  31  and orthodontic attachment  37  may each be optionally tapered to the occlusal or gingival for resistance from and path of draw in removal. 
         [0076]      FIG. 18A  shows an occlusal-gingival cross-section of the orthodontic bonding pad  39  that has reversibly received an orthodontic attachment. The bonding surface has a a mesial-distal living hinge  40  on the bonding surface such that the top occlusal side and protruding surface  41  can reversibly engage the upper occlusal side of an orthodontic attachment  37 , and the living hinge  40  is locked, and cannot be opened, upon bonding of the bonding surface of the orthodontic bonding pad  39  to the enamel of a tooth such that the head of the orthodontic bonding pad  39  is locked inside the retentive aspects of the orthodontic attachment  37  until the protruding surface  41  is removed.  FIG. 18B  shows the movement of living hinge  40  of  FIG. 18A  when the bonding surface of orthodontic bonding pad  39  is not bonded to the enamel of a tooth. Orthodontic attachment  37  can reversibly receive the head of orthodontic bonding pad  39  when the bonding surface of orthodontic bonding pad  39  is not bonded to the enamel of a tooth.  FIG. 18C  shows a mesial-distal cross-section of the embodiment of  FIG. 18A , with the retentive aspects  44 , shown here in the form of rails, of the orthodontic attachment  37  receiving the head  43  of the orthodontic bonding pad  39  by sliding into the stem  42 , shown here in the form of female depressions, of the orthodontic bonding pad  39 . The protruding surface  41  is an occlusal aspect of the living hinge  40  on the top occlusal side, and locks the orthodontic attachment  37  in place until the protruding surface  41  or top occlusal side is removed. 
         [0077]      FIG. 19  is a perspective view of the orthodontic bonding pad  39  shown in  FIGS. 18A ,  18 B, and  18 C. The orthodontic bonding pad  39  has a protruding surface  41  that eclipses the top occlusal side  45  when the living hinge  40  is closed. 
         [0078]      FIG. 20  is a perspective view of the orthodontic bonding pad  39  shown in  FIG. 19  bonded to a tooth  20 , the orthodontic bonding pad  39  locked inside an orthodontic attachment  37  until the protruding surface  41  is removed. 
         [0079]      FIG. 21  shows a lingual-labial cross-section view of an orthodontic bonding pad  47  that has received the base  48  of an orthodontic attachment with stem  52 . This alternative embodiment has retentive aspects in the form of tab  51  on the bottom gingival side and protruding surface  49  on the top occlusal side, and optional tabs  50  on the left and right sides. 
         [0080]      FIG. 22  shows a replica tooth  53 , preferably a three-dimensionally printed replica of a patient&#39;s tooth. Computer software determines the locations of positional markers  54 , which will cooperatively engage an orthodontic bonding pad such that the orthodontic bonding pad is appropriately positioned in the desired location on the tooth  53 , as indicated by silhouette  55 . 
         [0081]      FIG. 23  shows the replica tooth  53  of  FIG. 23 , with orthodontic bonding pad  56 , which will be preferably three-dimensionally printed to cooperatively engage the positional markers  54 , and which will reversibly receive orthodontic bonding pad  57 . 
         [0082]      FIG. 24  shows the back view of the bonding surface of orthodontic bonding pad  56 , which has reversibly received orthodontic attachment  58 . The bottom gingival side of the orthodontic bonding pad  56  is specifically shaped with notches  59  to cooperatively engage the two positional markers  54  on replica tooth  53 . By pre-determining positions of orthodontic bonding pads  56 , an orthodontist&#39;s assistant can prepare entire upper and lower jaw sets of properly positioned orthodontic bonding pads  56  on printed models, with positional markers  54  of the individual patient&#39;s dentition for the fabrication of indirect bonding trays, by matching up positional markers  54  to notches  59 . This is particularly advantageous because a doctor need only select positions of orthodontic attachments, and the replica tooth  53  and orthodontic bonding pad  56  are preferably three-dimensionally printed and positioned for quick bonding by an assistant, saving an orthodontist time. 
         [0083]      FIG. 25  shows an alternative embodiment of orthodontic bonding pad  56  with a specifically shaped singular bottom gingival side with irregular notch  59 , which identically matches the singular positional marker allowing occusal-gingival, mesial-distal, and lingual-labial positioning of bracket to tooth. 
         [0084]      FIG. 26  shows an alternative embodiment to the replica tooth  53  of  FIG. 23 , wherein a male-projection hash mark  61  is matched to a female similar mark  63  on the orthodontic bonding pad  62  for proper positioning. The advantage of the female similar mark  63  on the orthodontic bonding pad  62  is that it allows a defined hollow in the orthodontic bonding pad  62  to be filled with adhesive, ensuring a very thin coat of adhesive so that there will be minimal adhesive flash to clean up around the periphery of the orthodontic bonding pad  62  and orthodontic attachment  57  once attached. The orthodontic bonding pad  62  can reversibly receive orthodontic attachment  57 . 
         [0085]      FIG. 27  shows an orthodontic bonding pad  57  with an integrated index  64  attached on the top occlusal side. Ideally, the entire orthodontic bonding pad  57  and integrated index  64  assembly are three-dimensionally-printed in combination with orthodontic bonding pad  57  and integrated index  64  assemblies for an entire upper jaw or lower jaw set. The specific distance and projectional path between the integrated index  64  and the orthodontic bonding pad  57  reflects the calibrated positioning of the orthodontic bonding pad  57  in order to control occlusal-gingival, mesial-distal, and lingual-mesial positioning of the orthodontic bonding pad  57  on the patient&#39;s tooth. This is particularly advantageous because the anatomy of the tooth is captured in the integrated index  64  such that when the integrated index  64  is applied to the comparable tooth of the patient, the orthodontic bonding pad  57  will be bonded in the pre-selected position. This saves an orthodontist time in positioning orthodontic bonding pad  57  and the need to create a transfer or indirect bonding tray. 
         [0086]      FIG. 28  shows a front view of a patient&#39;s tooth  20 . The integrated index  64  has cooperatively engaged the occlusal surface of the tooth such that the orthodontic attachment  65 , and the orthodontic bonding pad  57  (not shown) that has reversibly received the orthodontic attachment  65 , will be placed in the pre-selected position on the tooth  20 . Subsequent to bonding, orthodontic device  66  is used to cut the integrated index  64  from the orthodontic bonding pad  57  (not shown). 
         [0087]    While the invention has been illustrated by a description of various embodiments and while these embodiments have been described in considerable detail, it is not the intention of the applicants to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. The invention in its broader aspects is therefore not limited to the specific details, representative methods, and illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of the inventive concept.