Download brackets in orthodontics

EVOLUTION OF
BRACKETS
PRESENTED BY
GUIDED BY
DR KHYATI MAHIDA
DR AJAY KUBAVAT
DR CHINTAN AGRAWAL
DR KETAN MASHRU
DR BHAVIK PATEL
DR MANISH DESAI
DR VISHAL PATEL
CONTENTS
• PRE-EDJUSTED EDGE WISE BRACKETS:
 Andrew’s straight wire appliance – 1970
 Roth’s modification – 1976
 Alexander Vari simplex brackets – 1978
 Burstone Segmented Arch technique
 Level anchorage System
 Mc Laughlin and Bennett and Trevisi
appliance
• OTHER EDGEWISE BRACKETS:
 Tip edge – 1980
 Combination arch technique – 1981
 Dual environmental brackets - 1990
 Bioefficient brackets - 1995
 Butterfly bracket system - 2004
ANDREW’S
STRAIGHT
WIRE
APPLIANCE
WHAT IS AN APPLIANCE:
 Defined as the basic components that are
attached to the teeth i.e. the bracket, the tubes
and other attachments.
Most of the adjustments that required highly
complicated archwire bends can be eliminated if
some of the treatment is "Built into the
appliance". The ultimate degree of sophistication
in this approach was introduced by Lawrence
Andrew with his straight wire appliance [SWA]
In 1929 - Angle angulated bracket and tubes to
effect tipping movement
In 1952 - Holdaway described three uses of
bracket angulation
•As an aid in paralleling roots adjacent to
extraction spaces
•As a method of settings up posterior
anchorage units into the tipped back or
anchorage prepared positions
•And as a means of obtaining correct axial
inclination or “artistic” positioning
1960 - Ivan Lee, suggested torqued slot
1960 - Manufacturers raised base of
brackets for laterals
1963 - Jarabak described the use of
torqued brackets and also angulated for
the upper anterior
1976 - Andrews S.W.A.
1979 - Roth modification
1983 - Alexander vari simplex
CLASSIFICATION OF BRACKET
1. Non programmed brackets
2. Partially programmed brackets
– Eg: Alexander Hilgers
– Burstone
3. Fully programmed brackets
– Eg: Andrews S.W.A
– Roth’s appliance
Straight wire – the concept and Appliance – L.
andrew
NON PROGRAMMED BRACKETS
 A set of brackets designed the same for all tooth
types, relying totally on wire bending to achieve the
optimal position for each individual tooth”
Straight wire – the concept and Appliance – L.
andrew
NEED FOR A MODIFYING BRACKET OF
EDGEWISE:
1. Bracket base are perpendicular to bracket
stems
2. Bracket bases are not contoured occlusogingivally
3. Slots are not angulated
4. Stems of bracket are of equal prominence
5. Maxillary molar offset not built in.
6. Bracket siting technique is unsatisfactory.
Straight wire – the concept and Appliance – L.
andrew
PARTIALLY PROGRAMMED
BRACKETS
 A set of brackets designed with some
built in features, but that always requires
some wire bending (less than the non
programmed brackets).
Even when attempts are made to align the
slots of partially programmed brackets
horizontally, the bracket heights vary
from anterior to posterior, resulting in
inconsistent and unpredictable torque
and in/out compensation.
DISADVANTAGE :
 Requires some amount of wire bending.
FULLY PROGRAMMED
BRACKETS
• Set of brackets designed to guide teeth directly
into their goal positions with unbent arch wires.
• In this type there is no need for wire bending.
• Mainly two types:
1. Standard Brackets
2. Translation series Brackets
• STANDARD BRACKETS:
 Consists of
1. Slot siting feature
2. Convenience features
3. Auxiliary features
• TRANSLATION BRACKETS:
Translation is defined as “uniform motion
of body in a straight line”
They have all features of standard brackets
plus a power arm & 2 additional slot siting
features, counter mesiodistal tip & counter
rotation.
• Mainly three categories:
a. Minimum translation bracket
b. Medium translational bracket
c. Maximum translation bracket
1. MINIMUM TRANSLATION BRACKETS:
–
It is recommended for the tooth which has to
translated 2mm or less
– Two types of them are
• 2° counter mesio-distal tip and a power
arm added to distogingival tie wing for distal
translation of tooth
• 2° subtracted if translation is to be mesial
since and power arm added to mesiogingival
tie wing.
2. MEDIUM TRANSLATION BRACKET:
 It is recommended for the tooth which has to
be translated more than 2mm but not more
than 4mm.
 3° degree of counter mesiodistal tip added or
subtracted.
 4° degree of counter rotation is incorporated.
 Maxillary 1st molar translational bracket has,
in addition to counter M-D tip and counter
rotations, 5° of counter buccolingual tip added
to the standard amount of positive intention
– Power arm added.
3. MAXIMUM TRANSLATION
BRACKETS:
 More than 4mm of translation
 4ºof counter mesidistal tip
 6º of counter rotation is incorporated.
PRESCRIPTION OF ANDREW
BRACKETS LISTS AND TYPES
BRACKET IDENTIFICATION
ORTHODONTIC TREATMENT
MECHANICS IN THE EARLY
YEARS OF SWA
WIDE RANGE
OF BRACKETS
VARIOUS
ARCHFORMS
BRACKETS
POSITIONED AT
CENTRE OF
CLINICALCROWN
HEAVY FORCE
LEVELS
ROTH
MODIFICATION
In 1979, Roth introduced a bracket setup
containing modifications of the tip, torque,
rotations and in out movement of the
Andrews standard setup brackets.
The purpose of the Roth setup was to
provide over corrected tooth positions prior
to appliance removal that would allow the
teeth in most instances to settle to what was
found is non orthodontic normals studied by
Andrews. The straight wire appliance 17 years later- Roth
ROTH BRACKETS
Roth setup is available in both 0.018 and 0.022 slot
The Roth set-up incorporated into it a member of
hooks for various types of elastic configuration and
also double triple and lip bumper tube for the use of
auxillary wires and attachments.
THE WORK OF ROTH
ROTH
BRACKETS
BRACKETS
POSITIONED AT
CENTRE OF
CLINICALCROWN
STANDARD WIDE
ARCH FORM
EMPHASIS ON
ARTICULATORS
Roth prescription
Andrews prescription
ALEXANDER
VARI
SIMPLEX
DISPLINE
 Given by Dr.Wick Alexander in 1978.
It is also called as Vari-Simplex discipline .
 Vari – refers to variety of bracket types.
 Simplex – Kiss principle (Keep it simple sir)
As archwires are simple, because first, 2nd, 3rd
order effects are incorporated into the bracket.
 Hooks are not soldered to wire. Bracket hooks
are used.
 Discipline - was chosen rather than appliance to
reflect that idea that the orthodontist must be
knowledgable in edgewise appliance and must play
a active role in application of appliance to the
individual patient in order that the treatment be
successful.
Alexander. R.G. (1986): The Alexander Discipline.
BRACKET SELECTION
• TWIN BRACKETS:
 Used on large, flatsurfaced teeth (namely,
maxillary central and
lateral incisors)
 The flat surfaces of
these teeth permit full
arch wire engagement
in the twin brackets
 There is little trouble
tying the wire into
these brackets because
of their ease of
accessibility
Twin Brackets are Convenient for
Ligating
Teeth Together & Placing Hooks
Semin Orthod 2001;7:62-66,)
 This bracket consists of the
basic 0.022" x 0.028" slot plus
a 0.017" x 0.025" vertical or
horizontal auxiliary tube
When placing this bracket on
the tooth, auxiliary tubes are
always placed gingivally
Ball hooks for elastic
placement are usually placed
on lateral incisor brackets.
The brackets allow for 5 to 6
mm of inter-bracket width,
which is sufficient for
flexibility, rotational control,
and torquing.
Also, these brackets are
smooth and minimize
irritation on labial tissues
• LANG BRACKETS:
Originally developed by
Dr. Howard Lang.
Used on large, roundsurfaced teeth at the
corners of the arch i.e.
maxillary & mandibular
cuspids.
The pad is contoured,
which fits on most
cuspids.
 The straight wing eliminates interference with complete arch wire
engagement. Thus, the bracket is easily ligated and inter-bracket width is
maximized.
 The wings can easily be activated for rotational control.
When a Lewis or Steiner Bracket is completely tied into a cuspid, there is a
tendency to flatten the curvature of the archwire. A Lang bracket avoids this effect,
while retaining the rotation wing capability.
• Twin brackets on cuspids are not the brackets of
choice because
They decrease the inter-bracket width, making it
more difficult to ligate & control rotations
It is often impossible to get full- bracket
engagement on these teeth early in treatment and
They can interfere with opposing cusps on
occlusion (actually often causing cusp attrition)
• LEWIS BRACKETS:
 Used on round-surfaced teeth not located at the corners of the arches
(maxillary and mandibular bicuspids) as well as small, flat-surfaced
teeth (mandibular incisors)
 The Lewis bracket is a fixed-wing single bracket that again contributes
positively to the concept of increased inter-bracket width. The wings
provide a distinct advantage in having a built-in auxiliary for rotational
control, much in the same fashion as those on the Lang bracket
LEWIS BRACKETS
SPECIFICATIONS OF THE
APPLIANCE
• BRACKET HEIGHT :
Bracket height in this Discipline, as in any
other technique, is extremely important in the
construction of the appliance
Bicuspid bracket height (x) is the key because
its clinical crown height is so variable
Other bracket heights are calculated in
relation to x
MAXILLARY ARCH
MANDIBULAR ARCH
Centrals
X
Centrals
X – 0.5mm
Laterals
X – 0.5mm
Laterals
X – 0.5mm
Cuspids
X + 0.5mm
Cuspids
X + 0.5mm
Bicuspids
1st Molars
X
X – 0.5mm
2nd Molars X – 1.0mm
Bicuspids
1st Molars
X
X – 0.5mm
• BRACKET ANGULATION:
To allow the roots to be properly positioned at the end of the
treatment, care is taken during the bracket placement to ensure
that the brackets are placed parallel to the long axis of the
clinical crowns
MAXILLARY ARCH
Banding
(Incisal edge
Reference)
Centrals
Laterals
Cuspids
Bicuspids and
Molars
MANDIBULAR ARCH
Banding
(Incisal edge
Reference)
Bonding
(Long axis
Reference)
3°
6°
6°
5°
8°
10°
0°
0°
Centrals
Laterals
Cuspids
Bicuspids
1st Molars
2nd Molars
2°
2°
6°
0°
– 6°
0°
Bonding
(Long axis
Reference)
2°
2°
6°
0°
– 6°
0°
• BRACKET TORQUES:
 The torque prescriptions used in this technique are
derived from measurement of the torques in the
rectangular archwires used to finish well treated
orthodontic cases.
MAXILLARY ARCH
MANDIBULAR ARCH
Centrals
Laterals
Cuspids
Bicuspids
Molars
Incisors
Cuspids
1st Bicuspids
2nd Bicuspids
1st Molars
2nd Molars
14°
7°
– 3°
– 7°
– 10°
– 5°
– 7°
– 11°
– 17°
– 22°
0° or – 27°
• THESE MEASUREMENTS DIFFER FROM COMMONLY USED
TORQUES IN THREE MAJOR RESPECTS
The -3º torque on the maxillary cuspids
compared to extremes of +7º to -7º in other
appliances, eliminates the need for adjusting
the torque later in the treatment
No torque is placed in the mandibular
second molar tubes, because of the use of
omega stops, which are always bent out to
avoid impingement on gingival tissue & to
avoid food trap. This automatically
incorporates torque in the wire
5 º of lingual crown torque or labial root
torque in the mandibular incisors
BURSTONE’S
SEGMENTED
ARCH
TECHNIQUE
BURSTONE’S MODIFICATION
 Burstone modified the canine bracket by adding a vertical
tube for the insertion of retraction assemblies.
 He also designed a 2nd premolar bracket with an auxiliary
tube.
COMBINATION OR CONVERTIBLE BRACKETS:
 Designed for use on first molar.
 They function as tubes until the 2nd molar are banded, at
which time removal of the metal tabs converts them into
brackets.
 In Burstone’s segmented
arch technique the
attachment used for the
cuspid is the Burstone’s
Cuspid Bracket
 This bracket consists of
the basic 0.022" x 0.028"
slot plus a 0.017" x
0.025" vertical or
horizontal auxiliary tube.
 When placing this
bracket on the tooth,
auxiliary tubes are always
placed gingivally
Burstone cuspid bracket
with either vertical tube or
an orthos horizontal tube
ROOT’S
LEVEL
ANCHORAGE
SYSTEM
 Developed by Terrell. L. Root
The level anchorage system is a complete,
orthodontic treatment designed for those
goal oriented orthodontists who could like to
treat efficiently to a predetermined goal and
reach that goal on a routine basis
It consists of a bonded or banded edgewise
appliance with built-in tip, torque and offset
and an analysis and treatment planning chart
with a step-by-step treatment procedure for
seven different extraction and non extraction
choices
Orthodontic current principles and techniques- Graber &
Swain
 Its consists of banded and bonded edge wise appliance with
built in torque, tip and offset and a treatment planning chart
with a step by step procedure.
CHARLES TWEED- ANCHORAGE PREPARATION
ANDREWS – STRAIGHT WIRE APPLIANCE
 LEVEL ANCHORGE SYSTEM- combination of anchorage
preparation and straight wire appliance.
 Bracket type- utilizes twin brackets for upper central incisors
and single lewis bracket for other teeth.
TIP EDGE
APPLIANCE
Tip- edge bracket was invented by Dr.Peter
Kesling .
Introduced differential tooth movement in
edgewise based bracket system.
As, its name suggests Tip Edge combines
initial degree of tooth tipping ,which greatly
facilitates tooth movement prior to edge wise
precision finishing.
Tip edge by Richard Park house
CHARACTERISTICS OF TIP
EDGE BRACKET:
 By removing the predetermined
,diagonally opposed corners from the
conventional edgewise slot, tip edge
bracket is created.
 Conventional tie wings and circular
marking on the distogingival wing for
identification on uppers and
triangular marking on lowers.
 A vertical slot is incorporated lingual
to main arch wire to accommodate
auxiliaries
 The shape of this slot is also known
as propeller slot
The cut out surfaces of the arch wire
slot forms the tip limiting surfaces
which restrict the degree of the tipping.
 The intact surfaces are finishing
surfaces,containg the the individualized
finishing prescription for each tooth.
The point at which tip limiting
surface and intact surfaces meet
constitutes a central ridge provide
vertical control and also torque is
imparted ,under the influence of
auxillary springs under the influence of
final rectangular wire phase.
The amount of tipping is dependent
on the angulations of cut portion of tip
limiting surface.
Anterior tip edge brackets are
designed to allow distal crown
tipping during translation in the
first stage of treatment.
But ,premolar brackets are selected
according to the extraction site.
Tip Edge employs double buccal tubes.
.022x.028 rectangular tubes with convertible
tubes.
0.036 inch internal diameter –gingival placed
round tube.
• ADVANTAGES:
 Automatic mesio-distal tip control
 Increased interbracket distance.
 Eliminates considered torque of the conventional edge –
wise appliance, thus less interferences in bite opening.
 Improved anchorage
TIP EDGE PLUS
Modified version of Rx – 1
tip edge bracket.
It has an additional
horizontal slot on the lingual
surface of the bracket .
It carries HANT auxiliary
arch wire to achieve up
righting root movements
instead of side winders.
Advantages- spring free
stage iii, oral hygiene, patient
comfort.
Mc LAUGHLIN,
BENNETT
AND TREVESI
Mc LAUGHLIN AND BENNETT
(1975-1993)
 Instead of initially modifying the basic bracket design,
for more than 15 yrs they developed and refined
treatment mechanics based on sliding mechanics and
continuous light forces mainly using standard SWA
brackets.
 They used middle of the clinical crown for bracket
positioning. They used medium sized standard ovoid
arch form for majority of cases.
 Their treatment mechanics recommendations
included accurate bracket positioning and lace backs
and bend backs for early anchorage controls with light
arch wire forces.
Mc LAUGHLIN, BENNETT AND
TREVESI(1993-1997)
Bennett and me Laughlin worked with Trevesi
and modified the entire bracket system to
complement their proven treatment philosophy
and to overcome the perceived inadequacies of
the original SWA.
• MODIFICATION:
The original system of dots and dashes was
superseded by laser numbering of standard size
metal brackets.
 The rectangular shape was replaced by
rhomboidal lines through only 2 planes, they by
assisting accuracy of bracket placement.
Bracket system was made available in
1. Standard metal
2. Mid sized
3. Clear forms
Light forces were being used in all stages of the
treatment
STANDARD
MID-SIZE
CLARITY
63
THE WORK OF MBT (19931997)
NEW
RANGE OF
BRACKETS
OVIOD ARCH
WIRE
SELECTION
BRACKETS
POSITIONED
WITH HELP OF
GAUGES
LIGHT
FORCE
LEVEL AND
SLIDING
MECHANICS
MC LAUGHLIN, BENNETT AND TREVESI
[1997-2001]
 In order to meet modern systemized method of
treatment mechanics, they recommended arch
form and selection and force levels.
 They recommended three basic shapes of arch
forms
1. Tapered
2. Square
3. Ovoid arch forms
 The modern system recommended the use of heat
activated nickel titanium wires for light forces.
MBT: Systemized
Orthodontic Treatment Mechanics, Mosby, St. Louis, 2001.
The modern orthodontist expects to have 3
main bracket systems available to meet the
needs of a typical caseload.
1.Standard sized metal brackets – where control
is mainly required
2. Mid sized metal brackets
THE WORK OF MBT (19931997)
NEW
RANGE OF
BRACKETS
BRACKETS
POSITIONED
WITH HELP OF
GAUGES
OVIOD,TAPERED
, SQURISH ARCH
WIRE
SELECTION
UPDATED
LIGHT FORCE
LEVEL AND
SLIDING
MECHANICS
THE VERSATILITY OF THE
BRACKET SYSTEM
• Aspects of versatility
1. Options for palatally displaced upper lateral incisors
2. Three torque options for upper canines
3. Three torque options for lower canines
4. Interchangeable lower incisor brackets
5. Interchangeable upper premolar brackets
6. Use of upper 2nd molar tubes on 1st molars
7. Use of lower 2nd molar tubes for upper molars of the
opposite side- when finishing to Class II molar
68
OTHER
BRACKETS
BIOEFFICIENT BRACKETS
 Given by ANTHONY D. VIAZIS
 Is system was mainly designed to shorten the time
consumed for initial leveling.
• BRACKETS:
 Triangular in shape- confirms the crown anatomy and
gingival contour.
 Low profile of bracket allows easy engagement of arch
wire.
JCO 1995: SEP, 29(9) 552-568
 Side elbows and wings of the
bracket allows easy
engagement of Elastomeric
modules.
 Minimum friction due to
increased interbracket span,
increased flexibilty of wire.
 Ease of bracket placement
 Tip control - is due to
narrow and elongated
configuration of bracket
 Rotational control.
COMBINATION ANCHORAGE
SYSTEM
 It is introduced by William J. Thompson in 1981.
 The concept of the appliance was to use a light wire
appliance system to establish the early organization of
malocclusion and then to finish the treatment with a
more rigid and precise straight wire appliance.
 With combination light wire mechanics it is possible to
use light wire mechanics at their optimum for rapid
anterior alignment, maximum retraction of anteriors
and good bite opening.
AM J ORTHOO DENTOFAC ORTHOP
1988;93:363-79.)
 At the desired point in treatment, the anchorage
resistance can be altered by changing slots, wire size
and friction to produce maximum edgewise control
and resistance in specific area of the appliance.
 For combination treatment, it is essential that the
combination anchorage bracket be designed to
produce optimum light wire / straight wire movements.
THE DUAL ENVIROMENT BRACKET
 Introduced by George F. Schudy in 1990.
 This edge wise bracket would offer a maximum range
of action of wires, yet still permit précise control with
small edge wise wires and require minimum change in
the techniques.
 Two slots: 1. Outer slot
2. Inner slot
JCO 1990 : FEB : 106-114
• LARGER OUTER SLOT:
- For maximum arch wire flexibility in the initial
phase.
- The outer slot measures 0.040 inch for twin
bracket and 0.030 inch for single bracket.
• SMALLER INNER SLOT:
- That accepts small rectangular wires for maximum
control later in treatment.
- The inner slot can be 0.016 or 0.018 inch
• ADVANTAGES:
The flexibility of the outer slot in some cases
allows the sue of a full size 0.016 x 0.022 inch
initial arch wire, even with a great deal of
irregularity.
The inner slot is used after rotations have been
partially corrected and vertical alignment has
been accomplished. Later in the treatment the
same full size arch wire can then be seated in
the smaller slot.
BUTTERFLY BRACKETS
Given by Dr. Bowman and
Dr. Carano.
The Butterfly system has
several unique features
designed to improve upon
existing PEA appliance
concepts in response to the
finding of ABO
JCO 2004 MAY ;VOL -38, 274- 287
• The Butterfly system is based on a new low
profile, miniature twin wing design and rounded
tie wings, elimination of hooks .
• FEATURES:
 Versatile vertical slot
 Progressive posterior
torque
 Reversible second
premolar brackets- +3o tip
to achieve good
intercuspation.
- in extraction cases -these
brackets are reversed to get
better root parallelism( -3o )
 Progressive mandibular anterior
tip
 Angulated first molar
attatchments -60 tip
 Mandibular anterior torque available at - 50 and -10
 Conservative anterior torque- 00
torque for upper canine and -30
for lower canine
 In deep bite cases it can be
inverted to get +30 to move
crowns labially back.
BIBILOGRAPHY
 Andrews L.F.: The straight wire - The concept and appliance
(C.V. Mosby Co.).
 Andrews L.F. (1990): JCO interviews, JCO 24, 493-508.
 Alexander. R.G. (1986): The Alexander discipline. (Glendora,
Ormco Corporation).
 Fogell. M.S., magill, J.M. (1963): The combination technique.
AJO, 49, 801-823.
 Fogell. M.S., magill, J.M. (1963): The combination technique.
AJO, 49, 801-823.
 George. F.Schudy (1990): Bracket design and wire flexibility.
JCO 24, 106-114.
 R.G. Alexander, The Vari-Simplex DisciplinePart 1
Concept and Appliance Design JCO 1983 Jun (380 –
392
 Cucalon; Clinical application of the universal
appliance; AJO-DO 1965 Jan (26 - 57).
TO BE CONTINUED…………..
o NEWER BRACKETS:
 Self-ligating brackets
» Active, passive
» Speed
» Activa
» Damon
» Edgelok
» Time
 Ceramic brackets
 Lingual orthodontics, Craven Kruz - 1975
THANK
YOU