Construction and application of technical specifications and procedures for four handed bonding of fixed orthodontic appliances

HE Jiao; SHANG Min; SUN Chao; WANG Zan; YU Min; ZHAO Xinyue; ZHANG Mengrui; LIU Lina

doi:10.3969/j.issn.2097-1753.2025.04.028

Abstract：Objective To develop technical specifications and procedures for four-hand operation in orthodontic fixed appliance bonding. Methods A three-round Delphi method was conducted from September 2022 to June 2023 with 21 experts to determine the content of the technical specifications and procedures. A total of 120 patients who received four-hand operation for orthodontic fixed appliance bonding at the Department of Orthodontics, Stomatological Hospital, Air Force Medical University, from July to November 2023 were selected and randomly divided into an observation group and a control group, each with 60 cases. The observation group received four-hand operation after standardized training, while the control group used the conventional cooperation model. The mean chairside operation time, single bracket bonding time, single bracket resin usage, and satisfaction of physicians and patients with nursing work were compared between the two groups. Results The effective questionnaire return rates for the three rounds of expert questionnaires were all 100%, with an expert authority coefficient of 0.95, and Kendall's W coefficients of 0.150 (χ²=110.147, P<0.001), 0.165 (χ²=121.327, P<0.001), and 0.618 (χ²=454.006, P<0.001). The constructed technical specifications for orthodontic fixed appliance bonding include five first-level items, 19 second-level items, and 36 third-level items, with a coefficient of variation of 0.00–0.09. After training, the observation group had significantly shorter mean chairside operation time, single bracket bonding time, and single bracket resin usage compared to the control group (t=73.091, 30.116, 6.603, all P<0.001), and higher satisfaction scores from both physicians and patients (t=9.355, 13.589, all P<0.001). Conclusion The constructed technical specifications and procedures for orthodontic fixed appliance bonding using four-hand operation are scientific and practical, providing a theoretical basis and practical direction for further standardizing orthodontic nursing and clinical work.