Abstract:
An insert is removably received in a channel of an orthodontic appliance. The insert substantially prevents sections of the appliance from moving toward each other a distance that would otherwise be sufficient for debonding the appliance from the associated tooth. The insert may be used with the appliance alone, or in combination with the appliance and a positioning tray. The insert may also be advantageously employed during manufacture, shipping, patient set-up or other handling, and may also be used in the course of treatment. Additionally, the insert may be provided with structure for serving as a positioning jig.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     This invention broadly relates to methods and articles used in the course of orthodontic treatment. More particularly, the present invention relates to methods and articles used in conjunction with orthodontic appliances that are bonded directly to the patient&#39;s teeth.  
         [0003]     2.Description of the Related Art  
         [0004]     Orthodontic treatment involves movement of a dental patient&#39;s teeth to improved positions in proper alignment with each other. Orthodontic treatment can greatly enhance the patient&#39;s facial appearance, especially in regions near the front of the oral cavity. Orthodontic treatment can also improve the function of the teeth so that the opposing teeth work better with each other during mastication.  
         [0005]     One type of common orthodontic treatment includes the use of a set of tiny appliances known as brackets. Each bracket has a slot and is affixed to one of the patient&#39;s anterior, cuspid or bicuspid teeth. Conventionally, a thin, resilient metallic archwire is received in the slots of the brackets and forms a track to guide movement of the teeth to desired positions. Ends of the archwire are often received in buccal tube appliances that are affixed to the patient&#39;s molar teeth.  
         [0006]     Another type of common orthodontic treatment system involves a series of custom-made plastic positioning trays such as the “Invisalign” brand trays sold by Align Technology of Santa Clara, Calif. Each tray is made to move the teeth a relatively small, incremental distance toward desired final positions. The trays are made of a plastic material with sufficient resiliency to urge the teeth toward positions defined by the tray when the tray is relaxed.  
         [0007]     However, plastic positioning trays sometimes have difficulty applying certain types of forces to teeth. For example, it is difficult for conventional positioning trays to apply a force in an extrusive direction (i.e., moving a tooth in a direction toward its outer tip). Moreover, the amount of force applied to the teeth is limited by the resiliency characteristics of the plastic material, which in general is somewhat less than can be applied to the teeth by the use of brackets and archwires.  
         [0008]     Some orthodontic practitioners have used a “combination” treatment plan, wherein the patient is provided with a series of the plastic positioning trays at the beginning stages of treatment. Subsequently, and after the teeth are located closer to desired final positions, the use of the trays is discontinued and replaced by brackets and archwires. It is often thought that the use of brackets and archwires in the final stages of treatment provides a better result in terms of moving the teeth to exact desired positions at the conclusion of treatment.  
         [0009]     It has also been proposed to use bonded orthodontic appliances simultaneously with plastic positioning trays. For example, U.S. Pat. Nos. 6,309,215 and 6,705,863 describe plastic positioning trays having receptacles for removably receiving appliances that are directly bonded to the patient&#39;s teeth. The bonded appliances can function as a handle to facilitate the transmission of force between the teeth and the positioning tray.  
         [0010]     Regardless of whether or not orthodontic appliances such as brackets are used alone or in combination with a repositioning tray, it is desirable that the appliances debond easily and predictably from the teeth at the conclusion of treatment. Metal brackets, for example, are typically debonded from teeth by using a peeling or prying motion. An improved ceramic bracket having a debonding channel is described in U.S. Pat. Nos. 5,439,379 and 5,366,372, and the bracket is debonded by pivoting sections of the bracket toward each other.  
         [0011]     However, it is also important to ensure that the orthodontic brackets do not spontaneously debond from the tooth before the practitioner intends to remove the brackets. If, for example, a bracket detaches from the tooth prior to the conclusion of treatment, the detached bracket must normally be re-bonded or replaced with a new bracket in order to resume the course of treatment. As can be appreciated, premature debonding of orthodontic brackets represents a significant nuisance to both the orthodontist and the patient that is best avoided if at all possible.  
       SUMMARY OF THE INVENTION  
       [0012]     The present invention concerns an orthodontic appliance and a removable insert that is received in a channel of the appliance. Once the insert has been removed from the channel, the appliance can be debonded from the tooth by moving sections of the appliance in a direction toward the channel. However, during the time that the insert is received in the channel, the insert substantially prevents movement of the sections to an extent that would be otherwise sufficient to debond the appliance from the tooth.  
         [0013]     Optionally, the appliance and the insert of the present invention can be used in combination with a resilient positioning tray having a receptacle for receiving the appliance. As the positioning tray exerts forces on the appliance during the course of treatment, the insert helps to reduce the risk that one or more sections of the appliance will be moved a distance sufficient to detach the appliance from the tooth.  
         [0014]     The appliance and insert of the present invention are also useful in instances when used alone and not in combination with plastic positioning trays. For example, the invention may be advantageously employed at any stage during handling of the appliance, to help insure that the appliance is not unduly distorted in shape or fractured before treatment has concluded. For example, the insert may be used during the time that the appliance is manufactured, shipped, handled in the practitioner&#39;s office, bonded to the patient&#39;s tooth and/or used as a force member during the course of treatment.  
         [0015]     In more detail, the present invention in one aspect is directed to an assembly that comprises an orthodontic appliance having a base for bonding the appliance to a tooth and a body extending outwardly from the base. The body includes a first section, a second section and an elongated channel extending between the first section and the second section. The appliance is debondable from the tooth by moving at least one of the first section and the second section in a direction toward the channel. The assembly also includes an insert that is removably received in the channel. The insert substantially prevents movement of the first section and the second section to an extent sufficient to debond the appliance from the tooth when the insert is received in the channel.  
         [0016]     The present invention is also directed in another aspect to a method of orthodontic treatment. The method comprises:  
         [0017]     bonding an appliance to a patient&#39;s tooth, wherein the appliance has a first section, a second section and an elongated channel extending between the first section and the second section;  
         [0018]     applying force to the appliance in order to move the tooth toward a desired position;  
         [0019]     removing an insert from the channel after the tooth has been at least partially moved toward the desired position; and  
         [0020]     debonding the appliance from the patient&#39;s tooth by moving at least one of the first section and the second section in a direction generally toward the channel.  
         [0021]     These and other aspects of the invention are described in more detail in the paragraphs that follow and are illustrated in the accompanying drawings. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0022]      FIG. 1  is a front elevational view looking in a lingual direction toward an orthodontic assembly made in accordance with one embodiment of the invention;  
         [0023]      FIG. 2  is an exploded, elevational view of the assembly shown in  FIG. 1 , looking in a direction toward a mesial side of the assembly;  
         [0024]      FIG. 3  is a bottom view of the assembly shown in  FIG. 1 , looking toward a gingival side of the assembly and showing, for illustrative purposes, the surface of the tooth upon which an appliance of the assembly is mounted;  
         [0025]      FIG. 4  is a view somewhat similar to  FIG. 3  except that an insert of the assembly has been removed from the appliance and sections of the appliance have been moved toward each other in order to debond the appliance from the tooth;  
         [0026]      FIG. 5  is a perspective view of an orthodontic assembly according to another embodiment of the present invention, looking at the assembly toward its gingival, mesial and buccolabial sides;  
         [0027]      FIG. 6  is a view somewhat similar to  FIG. 5  except showing the assembly in exploded view;  
         [0028]      FIG. 6   a  is a view somewhat similar to  FIG. 6  except showing an orthodontic assembly in accordance with another embodiment of the invention;  
         [0029]      FIG. 7  is a front elevational view of the orthodontic assembly shown in  FIGS. 5 and 6 , looking at the assembly in a lingual direction;  
         [0030]      FIG. 8  is an end elevational view of the assembly shown in  FIGS. 5-7 , looking at the assembly in a direction toward its occlusal side;  
         [0031]      FIG. 9  is a perspective view of an orthodontic assembly according to another embodiment of the present invention, wherein the assembly includes an orthodontic appliance, a removable insert and a plastic positioning tray, and wherein also is shown an exemplary upper dental arch of an orthodontic patient undergoing treatment;  
         [0032]      FIG. 10  is an enlarged view of a portion of the orthodontic assembly illustrated in  FIG. 9 ;  
         [0033]      FIG. 11  is a view somewhat similar to  FIG. 10  except in accordance with another embodiment of the present invention;  
         [0034]      FIG. 12  is a side cross-sectional view, looking in a mesial direction, of an orthodontic assembly according to still another embodiment of the present invention, wherein the assembly includes an orthodontic appliance, a removable insert and an indirect bonding tray for facilitating bonding the appliance to a tooth surface; and  
         [0035]      FIG. 13  is a fragmentary plan view illustrating another embodiment of the present invention, wherein a number of inserts for different appliances are integrally connected together. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0036]     An orthodontic assembly according to one embodiment of the present invention is illustrated in  FIGS. 1-4  and is broadly designated by the numeral  20 . The assembly  20  includes an orthodontic appliance  22  having an elongated channel  24 . The assembly  20  also includes an insert  26  that is removably received in the channel  24 .  
         [0037]     In more detail, the appliance  22  includes a mesial section  28  and a distal section  30 . The channel  24  extends between the mesial section  28  and the distal section  30 . Each of the sections  28 ,  30  includes an occlusal tiewing  32  (i.e., a tiewing extending toward the outer tip of the tooth) and a gingival tiewing  34  (i.e., a tiewing extending toward the gingiva or gums). The tiewings  32 ,  34  extend over ligature-receiving undercuts or grooves of the appliance  22 .  
         [0038]     An archwire slot  36  extends in a generally mesial-distal direction in the mesial section  28  and the distal section  30 , and preferably has spaced-apart, parallel, occlusal and gingival walls interconnected by a perpendicular bottom wall. Preferably, the walls are constructed to matingly receive an archwire having a rectangular cross-section for facilitating the transfer of forces between the archwire and the appliance  22  without undue tolerance or “slop”.  
         [0039]     The channel  24  ( FIGS. 3 and 4 ) extends in a generally occlusal-gingival direction between the mesial section  28  and the distal section  30 . As can be observed by comparing  FIG. 3  with  FIG. 2 , the channel  24  preferably has a depth in a lingual direction (i.e., in a direction toward the patient&#39;s tongue) that is greater than the lingual depth of the archwire slot  36 . In this embodiment, the channel  24  has a rectangular configuration in transverse cross-section and extends from the occlusal side to the gingival side of the appliance  22 .  
         [0040]     The mesial section  28  includes a base having an external lingual bonding surface  38 . Similarly, the distal section  30  includes a base with an external lingual bonding surface  40 . In this embodiment, the base of the mesial section  28  and the base of the distal section  30  are integrally connected by a thin, frangible web  42  that extends directly beneath and along the entire length of the channel  24 . The web  42  overlies a groove that extends in a direction parallel to the longitudinal axis of the channel  24 .  
         [0041]     As can be observed by reference to  FIG. 3 , the web  42  interconnects the bonding surfaces  38 ,  40  of the mesial and distal sections  28 ,  30 . Preferably, the surfaces  38 , 40  together present a concave, compoundly curved configuration that matches the convex, compoundly curved shape of the surface of a tooth ( FIGS. 3 and 4 ) to which the appliance  22  is adhesively bonded. Optionally, the channel  24  has a rounded bottom (not shown) to enhance fracturing of the web  42  generally in a reference plane that coincides with the central, longitudinal axis of the channel  24 .  
         [0042]     The insert  26  in this embodiment has a generally flat shape. A first portion  44  of the insert  26  is received in the channel  24 . At least one region of the first portion  44  has a thickness in a mesial-distal direction that is substantially equal to the width of the channel  24  in a mesial-distal direction. For example, the first portion  44  may have a substantially rectangular cross-sectional shape as exemplified in  FIG. 3  when viewed in a gingival direction. Alternatively, the first portion  44  may have a tapered shape or other shape that helps to reduce friction between the insert  26  and the sections  28 ,  30  when the insert  26  is removed from the channel  24 . However, at least part of the first portion  44  has a shape or thickness sufficient to prevent movement of one or both of the sections  28 ,  30  a distance sufficient to detach one or both of the sections  28 ,  30  from the tooth  64  as will be described in further detail below.  
         [0043]     Optionally, and as shown in  FIG. 2 , the first portion  44  includes a notch  45  as shown in  FIGS. 1 and 2 . The notch  45  coincides with the archwire slot  36  when the insert  26  is received in the channel  24 , so that the insert  26  may remain in place in the appliance  22  during treatment. However, the notch  45  may be omitted in instances where the insert  26  is to be removed before an archwire is placed in the archwire slot  36 .  
         [0044]     Preferably, the insert  26  also includes a second portion  46  that is integrally connected to the first portion  44 . The second portion  46  extends outwardly past the confines of the channel  24  a distance sufficient to enable grasping or moving the insert  26  by a hand instrument. In the illustrated embodiment, the second portion  46  extends in a gingival direction. Alternatively, however, the second portion could extend in a buccolabial direction (i.e., in a direction toward the patient&#39;s lips or cheeks) outwardly past the buccolabial side of the appliance  22  or in an occlusal direction. As a further option, the second portion  46  may extend outwardly from the first portion  44  in two or more directions.  
         [0045]     When the insert  26  is received in the channel  24  as shown in  FIG. 3 , the insert substantially prevents movement of the sections  28 ,  30  toward each other. To this end, the insert  24  functions as a stop to limit movement of either or both of the sections  28 ,  30  a distance sufficient to fracture the adhesive bond between the bonding surfaces  38 ,  40  respectively and the enamel surface of the tooth  64 . By limiting movement of the section  28 ,  30 , the insert  26  also helps to ensure that the web  24  does not unintentionally fracture.  
         [0046]     When the orthodontic practitioner desires to remove the appliance  22  from the tooth  64 , a hand instrument such as a ligature director or mosquito forceps is used to remove the insert  26  from the channel  24 . Next, a pliers-type tool, such as the debonding tool described in U.S. Pat. Nos. 5,439,379 and 5,366,372, is used to fracture the adhesive bond between the appliance  22  and the tooth. To this end, one jaw of the pliers-like debonding tool is placed in a position to engage a mesial side of the mesial section  28  in areas adjacent to the occlusal tiewing  32  and gingival tiewing  34  of the mesial section  28 , while the remaining jaw is placed to engage a distal side of the distal section  30  in areas adjacent the occlusal tiewing  32  and the gingival tiewing  34  of the distal section  30 . The jaws of the tool engage the sides of the appliance  22  in buccolabial areas of the sections  28 ,  30 , and preferably do not engage those portions of the sections  28 ,  30  that are located in a lingual direction relative to the bottom of the channel  24 .  
         [0047]     Next, the practitioner uses the tool to urge the engaged mesial and distal sides of the sections  28 ,  30  in a direction toward each other in such a manner that one or both of the sections  28 ,  30  pivotally move toward each other in an arc about a reference axis that is generally parallel to the longitudinal, central axis of the channel  24 . As one or both of the sections  28 ,  30  move from the orientations shown in  FIG. 3  and toward the orientations shown in  FIG. 4 , the web  42  fractures in the manner illustrated in  FIG. 4 , thereby enabling the bonding surfaces  38 ,  40  to detach from underlying areas of the tooth.  
         [0048]     In this embodiment, the appliance  22  is made of a ceramic material that fractures as the sections  28 ,  30  are moved toward each other and toward the channel  24 . Preferably, the ceramic material is a translucent or transparent ceramic material such as monocrystalline or polycrystalline alumina. Preferably, the ceramic material exhibits a light transmittance sufficient for the color of the tooth to be visible through the appliance  22  or for the appliance  22  to assume the color of the underlying tooth. Suitable polycrystalline ceramic materials are described in U.S. Pat. Nos. 4,954,080 and 6,648,638, the disclosures of which are incorporated by reference herein. In addition to polycrystalline and monocrystalline alpha-alumina, other ceramics may also be used, such as porcelain, glass, glass-ceramics and the like.  
         [0049]     Additional aspects concerning the appliance  22  as well as other alternative constructions are set out in U.S. Pat. Nos. 5,439,379 and 5,366,372, the disclosures of which are also hereby expressly incorporated by reference herein.  
         [0050]     Alternatively, the appliance  22  is comprised of materials other than ceramic, such as metallic materials or plastic materials. Suitable metallic materials include alloys of stainless steel, such as series 300 stainless steel and 17-4 PH stainless steel. Suitable plastic materials include polycarbonate, which is optionally reinforced with glass fibers.  
         [0051]     The insert  26  may be made of any one of a number of materials. Preferably, the insert is made of a material that is suitable for sustained use in the oral environment and is not susceptible to significant staining by food or beverages in instances where the insert  26  is intended to remain in the channel  24  during all or a portion of treatment. Suitable materials include plastic materials such as polyurethane and polycarbonate.  
         [0052]     An orthodontic assembly  20   a  according to another embodiment of the invention is illustrated in  FIGS. 5-8 . The assembly  20   a  includes an appliance  22   a  having a channel  24   a  ( FIG. 6 ). The assembly also includes an insert  26   a  that is removably received in the channel  24   a.    
         [0053]     The appliance  22   a  also includes an archwire slot liner  48   a  that is connected to a mesial section  28   a  and a distal section  30   a  of the appliance  22   a.  The archwire slot liner  48   a  has an occlusal section  50   a,  a lingual section  52   a  and a gingival section  54   a.  The occlusal section  50   a  and the gingival section  54   a  preferably extend in parallel reference planes and the lingual section  52   a  preferably extends in a reference plane perpendicular to the sections  50   a,    54   a.  The sections  50   a,    52   a,    54   a  together present an overall, generally “U”-shaped configuration when viewed in directions along the longitudinal of the axis of the archwire slot liner  48   a.  In addition, the sections  50   a,    52   a,    54   a  together define an archwire slot for receiving an archwire (not shown in the drawings).  
         [0054]     The archwire slot liner  48   a  is connected to the mesial section  28   a  and the distal section  38   a  by any one of a number of methods. For example, an adhesive, such as an epoxy or a dental or orthodontic adhesive may be used. Other methods include a soldering process, a brazing process and a glazing technique. Examples of suitable brazing processes include the processes described in U.S. Pat. Nos. 5,358,402 and 5,380,196, both of which are expressly incorporated by reference herein. An example of a suitable glazing technique involves the use of a glass paste or slurry that is heated to its softening or melting temperature.  
         [0055]     Additional aspects and alternative constructions of the archwire slot liner  48   a  are described in applicant&#39;s pending U.S. Patent Application entitled “CERAMIC ORTHODONTIC APPLIANCE WITH ARCHWIRE SLOT LINER”, Ser. No. 10/730344, filed Dec. 8, 2003.  
         [0056]     The insert  26   a  includes a first portion having an occlusal leg  56   a  and a gingival leg  58   a  as illustrated for example in  FIG. 6 . When the insert  26   a  is received in the channel  24   a,  the legs  56   a,    58   a  straddle the archwire slot liner  48   a  and extend in a generally lingual direction toward the bottom of the channel  24   a.  Preferably, the insert  26   a  also includes a second portion  46   a  that extends beyond the buccolabial side of the appliance  22   a  to facilitate grasping of the insert  26   a  and removal from the channel  24   a  when desired.  
         [0057]     Other aspects of the assembly  20  are essentially identical to the aspects of the assembly  20  described above. As such, a detailed description of the similar aspects need not be repeated.  
         [0058]     An orthodontic assembly  20   a ′ constructed in accordance with another embodiment of the invention is illustrated in  FIG. 6A . The assembly  20   a ′ is essentially the same as the assembly  20   a  except for the aspects described below.  
         [0059]     The assembly  20   a ′ includes an appliance  22   a ′ as well as an insert  26   a ′. The insert  26   a ′ has a first portion with an occlusal leg  56   a ′ and a gingival leg  58 ′. The insert  26   a ′ also includes a second portion  46   a ′ that is integrally connected to the first portion.  
         [0060]     In this embodiment, the second portion  46   a ′ extends beyond the buccolabial side of the appliance  22   a ′, and also extends beyond the occlusal side of the appliance  22   a ′. The second portion  46   a ′ includes a leg  47   a ′ for engagement with the outer or occlusal tip of the patient&#39;s tooth.  
         [0061]     The length of the second portion  46   a ′ is selected so that the appliance  22   a ′ is properly positioned in a vertical or occlusal-gingival direction on the patient&#39;s tooth when the leg  47   a ′ is in contact with the occlusal tip of the patient&#39;s tooth. Consequently, the insert  26   a ′ functions as a positioning jig to facilitate bonding the appliance  22   a ′ in a proper, pre-defined position on the tooth. Optionally, the leg  47   a ′ may have additional structure for facilitating orientation of the appliance  22   a ′ in a mesial-distal direction on the tooth. For example, the leg  47   a ′ may include structure resembling a cap that matingly fits over the occlusal edge portion of the patient&#39;s tooth to provide a custom positioning jig that helps to position the appliance  22   a ′ in both an occlusal-gingival direction as well as in a mesial-distal direction. As another option, the leg  47   a ′ may be omitted, and the second portion may be provided with notches, index marks, shoulders or other indicia to help position the appliance  22   a ′ in an occlusal-gingival direction relative to the occlusal edge of the tooth.  
         [0062]     An orthodontic assembly  20   b  according to another embodiment of the invention is illustrated in  FIG. 9 . The assembly  20   b  includes at least one orthodontic appliance such as appliance  22   b  that is mounted on the patient&#39;s first bicuspid tooth. The assembly also includes an insert  26   b  that is received in a channel of the appliance  22   b,  as well as a resilient positioning tray  60   b.    
         [0063]     The resilient or elastic positioning tray  60   b  has a cavity or receptacle for removably receiving the appliance  22   b  when the tray  60   b  is worn over the teeth. Preferably, the position of the receptacle relative to remaining portions of the tray  60   b  is selected to facilitate the transfer of a force between the tooth bonded to the appliance  22   b  and the tray  60   b.  To this end, the receptacle preferably has a shape that is complemental to the exterior surface of the appliance  22   b,  so that force can be transferred between the appliance  22   b  and the tray  60   b  without excessive tolerance or “slop”.  
         [0064]     Preferably, the appliance  22   b,  the insert  26   b  and the tray  60   b  are all made of aesthetic materials that transmit light. For example, the appliance  22   b  may be made of a ceramic material that is translucent or transparent as mentioned above in connection with the appliance  22 . The insert  26   b  as well as the tray  60   b  may be made of polymeric materials that transmit light, such that the polymeric materials mentioned above in connection with the insert  26 . Suitable materials for the tray  60   b  include 0.03 inch thermal forming dental material, available from Tru-Tain Plastics.  
         [0065]     Optionally, the tray  60   b  is one of a series of thin repositioning shells or trays representing successive stages of an orthodontic treatment program. Optionally, the tray  60   b  includes cavities shaped to receive and resiliently reposition teeth in incremental positions, such that the final tray moves the teeth to a final tooth arrangement. Examples of suitable positioning trays are described in U.S. Pat. Nos. 6,309,215 and 6,705,863, the disclosures of which are expressly incorporated by reference herein.  
         [0066]     The appliance  22   b  and the insert  26   b  are shown in enlarged view in  FIG. 10 . The appliance  22   b  includes a mesial section  28   b  and a distal section  30   b,  as well as a channel  24   b  that extends between the sections  28   b,    30   b  in a generally occlusal-gingival direction. To debond the appliance  22   b  from a tooth such as tooth  64   b,  one or both of the sections  28   b,    30   b  are moved in a direction toward the channel  24   b,  similar to the debonding of the appliance  22  as set out above.  
         [0067]     As shown in  FIG. 10 , the appliance  22   b  includes a tapered occlusal side that is presented by a tapered surface  66   b  of the mesial section  28   b  and a tapered surface  68   b  of the distal section  30   b.  The tapered surfaces  66   b,    68   b  help to seat the tray  60   b  into a proper position. The receptacle of the tray  60   b  preferably also has tapered inner surfaces that match the shape and orientation of the tapered surfaces  66   b,    68   b  of the appliance  22   b.    
         [0068]     In  FIG. 11 , an orthodontic assembly includes an appliance  22   c  that is similar to the appliance  22   b.  However, the appliance  22   c  includes an occlusal section  70   c  and a gingival section  72   c.  A channel  24   c  extends in a generally mesial-distal direction between the occlusal section  70   c  and the gingival section  72   c,  and an insert  26   c  is removably received in the channel  24   c.    
         [0069]     When it is desired to debond the appliance  22   c  from the tooth (such as tooth  64   c ), one or both of the occlusal section  70   c  and the gingival section  72   c  are moved in a direction toward the channel  24   c  by exerting a force in the occlusal and/or gingival direction as desired. The appliance  22   c  then debonds from the tooth in a manner similar to debonding of the appliances  22 ,  22   a,  and  22   b.    
         [0070]     Other aspects of the appliances  22   b,    22   c  and the inserts  26   b,    26   c  are similar to the appliances  22 ,  22   a  and the inserts  26  and  26   a  set out above.  
         [0071]     An orthodontic assembly  20   d  according to another embodiment of the invention is illustrated in  FIG. 12 . The assembly  20   d  includes an appliance  22   d  and an indirect bonding tray  73   d.  The appliance  22   d  is similar to the appliance  22   a  illustrated in  FIGS. 5-8 .  
         [0072]     The indirect bonding tray  73   d  includes an outer shell  78   d  and a matrix material  80   d  that is received in the shell  78   d.  The matrix material  80   d  includes a cavity  79   d  having a construction that matches at least a portion of the patient&#39;s dental arch.  
         [0073]     At least one orthodontic appliance is releasably connected to the indirect bonding tray  73   d.  Preferably, a number of orthodontic appliances are releasably connected to the indirect bonding tray  73   d  so that a number of teeth can be bonded to appliances simultaneously. In  FIG. 12 , the illustrated appliance  22   d  is a bracket as described above in connection with appliance  22   a,  although other appliances such as buccal tubes, buttons and other attachments are also possible.  
         [0074]     The appliance  22   d  includes a base  74   d  that preferably has a configuration that precisely matches a portion of the patient&#39;s tooth structure  64   d.  A quantity of a bonding adhesive  76   d  extends across the base  74   d,  and serves to fix the appliance  22   d  to the patient&#39;s tooth  64   d  with a bond having sufficient strength to resist unintended detachment from the tooth  64   d  during the course of treatment. Preferably, the bonding composition  76   d  is applied by the manufacturer to the base  74   d  before such time as the indirect bonding tray  73   d  is made and shipped to the practitioner.  
         [0075]     A portion of the matrix material  80   d  extends into the channel of the appliance  22   d.  This channel is not shown in detail in  FIG. 12 , but is essentially the same as the channel  24   a  illustrated in  FIG. 6 . The portion of the matrix material  80   d  that extends in the channel provides an insert that prevents mesial and distal sections of the appliance  22   d  to be moved toward each other a distance that would otherwise be sufficient for debonding the appliance  22   d  from the tooth, similar in function to the insert  26   a  as described above.  
         [0076]     Once the indirect bonding tray  73   d  is placed over the patient&#39;s tooth structure including tooth  64   d,  the bonding composition  76   d  is allowed to harden. Subsequently, the indirect bonding tray  73   d  is detached from the dental arch including the tooth  64   d  and is also detached from the appliances including appliance  22   d,  leaving the appliances affixed to respective teeth. As the tray  73   d  is detached from the appliance  22   d,  the portion of the matrix material  80   d  that was previously located within the channel of the appliance  22   d  is simultaneously removed from the channel. The appliance  22   d  can then be debonded from the tooth  64   d  when desired by moving one or both of the mesial and distal sections of the appliance  22   d  toward each other.  
         [0077]     Further details of construction of the indirect bonding tray  73   d  are described in applicant&#39;s U.S. pending patent application entitled “METHOD AND APPARATUS FOR INDIRECT BONDING OF ORTHODONTIC APPLIANCES”, Ser. No. 10/428301, filed May 2, 2003 and pending U.S. patent application entitled “APPARATUS FOR INDIRECT BONDING OF ORTHODONTIC APPLIANCES AND METHOD OF MAKING THE SAME”, Ser. No. 10/678286, filed Oct. 3, 2003, this disclosures of which are both hereby expressly incorporated by reference herein.  
         [0078]      FIG. 13  is an illustration of another embodiment of the invention, which includes a number of inserts  26   e  that are each similar to the inserts  26   a  described above. Each of the inserts  26   e  is integrally connected to an elongated, strip-like substrate  82   e  to present a single, unitary insert device  84   e.  Preferably, the space between adjacent inserts  26   e  is equal to the spacing between channels of adjacent appliances when the appliances are mounted on the patient&#39;s teeth.  
         [0079]     Preferably, the insert device  84   e  is received in the channels of all or at least a majority of all of the appliances mounted on a patient&#39;s dental arch. As an example, the insert  84   e  may be used in instances where the appliances are covered by a plastic repositioning tray (such as the tray  60   b  mentioned above). When the portion of orthodontic treatment using the tray has concluded, the tray is removed from the dental arch to uncover the insert device  84   e.  Next, the practitioner can detach the insert device  84   e  from all of the appliances in a single step before an archwire is inserted in the archwire slots of the appliances. The insert device  84   e  provides a timesaving to the practitioner, in that each of the inserts for each corresponding appliance need not be removed in separate, sequential steps.  
         [0080]     Optionally, the insert device  84   e  may be connected to the positioning tray. For example, the insert device  84   e  as it appears in  FIG. 13  may be adhesively bonded to the inner walls of the positioning tray. As another option, the insert device  84   e  may be integrally molded with the inner walls of the positioning tray.  
         [0081]     Preferably, the substrate  82   e  and the inserts  26   e  are made of aesthetically pleasing transparent or translucent materials, such as the polymeric materials described in the paragraphs above.  
         [0082]     The examples described herein and illustrated in the accompanying drawings are intended to be illustrative of the invention. The invention should not be deemed limited to the specific examples described in detail, but instead only by a fair scope of the claims that follow along with their equivalents.