When preparing tooth surfaces by polishing, etching, and scaling for direct or indirect bonding,1 or when removing adhesive for debonding, orthodontists should take strict precautions to prevent COVID-19 transmission by minimizing the production of droplets and aerosols.2,3 A four-handed technique using low- and high-volume saliva evacuators has recently been recommended to control droplets and aerosols,3 but this requires two operators. Here is a “2for2” technique that utilizes a double saliva evacuator and two working hands, thus exposing only one operator to the risk of contagion.


  1. Isolate the dentition to ensure a dry field.**
  2. Connect the low-volume evacuator to the rear connectors.
  3. Tie the high-volume evacuator to the front connector using a 5/16″, 2oz orthodontic elastic.
  4. Position the front evacuator at the desired height for the upper or lower arch.
  5. Use a slow-speed handpiece.

Because these materials and equipment are readily available in an orthodontic office, the technique is inexpensive and can be applied immediately. It has the following additional advantages:

  • Droplets and aerosols are controlled in both the anterior and posterior areas of the mouth.
  • The front high-volume evacuator is flexible enough to be used on either side of the upper or lower arch.
  • The technique can be applied in other dental specialties for situations where rubber dams cannot be used.
  • Only one operator needs to be present, reducing the risk of infection to orthodontic staff by 50%.


*Private practice, Città Sant’Angelo, Viale Matrino 124, 65013 Pescara, Italy; e-mail: fabio@studiociuffoloferritto.it.
**NOLA Dry Field System, Great Lakes Dental Technologies, Tonawanda, NY; www.greatlakesdentaltech.com.


1. Ciuffolo, F.; Tenisci, N.; and Pollutri, L.: Modified bonding technique for a standardized and effective indirect bonding procedure, Am. J. Orthod. 141:504-509, 2012.
2. Seto, W.H.; Tsang, D.; Yung, R.W.H.; Ching, T.Y.; Ng, T.K.; Ho, M.; Ho, L.M.; and Peiris, J.S.M.: Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS), Lancet 361:1519-1520, 2003.
3. Meng, L.; Hua, F.; and Bian, Z.: Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine, J. Dent. Res. 99:481-487, 2020.

Dr Fabio Ciuffolo
Responsabile dell’Ortodonzia, per adolescenti e adulti, e della Gnatologia


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