ORTHODONTIC BRACKETS

SELECTION, PLACEMENT AND DEBONDING

Dr. Haris Khan

B.D.S., F.C.P.S,F.F.D RCSI
Assistant Professor Orthodontics
The University Of Lahore
Pakistan
COPYRIGHT

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form
or by any means, including photocopying, recording, or other electronic or mechanical methods, without
the prior written permission of the publisher, except in the case of brief quotations embodied in critical
reviews and certain other noncommercial uses permitted by copyright law. For permission requests, write
to the publisher, or contact at drhariskhan@gmail.com

PUBLICATION DATA

ISBN-13: 978-1508936275
ISBN-10: 1508936277

Library of Congress Control Number: 2015905934

CreateSpace Independent Publishing Platform, North Charleston, SC

DEDICATION

This book is dedicated to my supervisors Dr. M. Waheed ul Hamid and Dr. Irfan ul Haq

ACKNOWLEDGEMENT
I highly acknowledge the efforts and inspiration made by Dr. Ateeq ul Reham to write this book. I am
thankful to Dr. Fayyaz Ahmad and Dr. Munawer Manzoor for providing me the technical guidance on
various aspects of brackets. I am also thankful to Dr. Erum Bashir for doing the proofreading, Dr. lubna
batool for provided used brackets from her clinical practice and Mr Jahanzeb for doing the composing
of this book.

CONTRIBUTOR, EDITOR AND AUTHOR

Dr. Haris Khan

B.D.S , F.C.P.S,F.F.D RCSI
Assistant Professor Orthodontics
UOL, Pakistan
 PREFACE
In this era of pre-adjusted brackets, the existing literature on orthodontics limits itself
to wire bending treatment practices. Since contemporary authors were not trained on the
pre-adjusted bracket mechanics, hence they were handicapped to broach on the subject at
the relevant point in time. In present day orthodontics, many orthodontists still resort to wire
bending methods to close extraction spaces or to correct three dimensional positions of the
teeth.

Chapters on orthodontic brackets in various books either focus on theoretical

perspective or are devoid of essential correlation of brackets,vis-a-vis their intended clinical
use. Some authors have depicted fancy graphics to demonstrate clinical use of brackets.

To address such obvious lacunae, I started working on orthodontic brackets in the

year 2012 by collecting the brackets which were debonded during my clinical practice.This
took me through the entire literature on orthodontic brackets as presented in various journals
and manufacturer catalogues. This provided me an access to real time pictures of brackets
using special micro lenses and portable microscopes.

This book was authored to cater for all aspects of orthodontic brackets. The focus
being to provide students with real time pictures of different brackets available in the market
and to determine their behaviour in oral cavity and their appearance after debonding. The
main emphasis being on three vital aspects viz; the selection, placement and debonding,this
book has accordingly been designed to comprise these three sections. Real times of new and
used brackets have been specifically included to provide the students a realistic insight of
brackets.Care has been taken to ensure correlation of clinical situation and various bracket
selection criterions.

This book has materialized after an enormous effort of two years in data collection
and a year further in arranging the data in a convenient book form.

I deeply acknowledge the help and encouragement provided my colleagues in

consummating this endeavor.

I earnestly hope that this effort would go a long way in providing ready help to
students.

Haris Khan
Table of Contents
Historical Perspective of Orthodontic Brackets 1

Material Perspective of Orthodontic Brackets 13

Selection of Bracket Base 41

Selection of Bracket Slot 61

Selection of Auxiliary and Convenience features 77

Selection of Bracket Prescription 83

Placement of Orthodontic Brackets 153

Bonding in Orthodontics 189

Debonding of Orthodontic Brackets 203

Adhesive Remnants Removal 239

Recycling of Orthodontic Brackets 255


Historical Perspective of Orthodontic Brackets
In this Chapter
History
Pierre Fauchard
Modifications of bandeau appliance
Development of edgewise appliance
E Arch
Pin and Tube Appliance
Ribbon Arch Appliance
Edgewise Appliance
Orthodontic brackets are important part of fixed
appliances which are temporarily attached to
the teeth during the course of orthodontic
treatment. They are used to deliver forces from
the wires or other power modules to the teeth.
Before going into the details of orthodontic
brackets a historic preview on the evolution of
brackets is given.
History
The origin of orthodontic brackets can well be
coined with the origin of orthodontics and the
human desire to align crooked teeth. The first
written record1 to correct crowded or protruded
teeth is found 3000 years ago. Orthodontic
appliances to correct maligned teeth have been
found in Greek, Etruscan and Egyptian artifacts
2
.These ranges from crude metal wire loupes to
metal bands wrapped around individual teeth in
ancient Egyptian mummies3. Pliny the Elder
1
CHAPTER
1
Begg Appliance
Other Appliances
Modification of Standard Edgewise Appliance
Self ligating brackets
Light wire Appliances
Lingual brackets
Customized labial brackets
(23-79 AD) was the first to mechanically align
elongated teeth4.
Pierre Fauchard
Pierre Fauchard (1678 –1761) a French dentist
was the first to make a scientific attempt to align
irregular teeth by an appliance named Bandeau
(Figure 1.1 & 1.2).This appliance was made of
precious metal and it was shaped like a horse
shoe to align teeth by arch expansion. Fauchard
also used to reposition irregular teeth with his
Pelican forceps and then ligate them with
neighboring teeth until healing took place.
Fauchard published his work in 1728 in his
landmark book entitled The Surgeon Dentist: A
Treatise on the Teeth.

Historical perspective of Orthodontic Brackets
Figure 1.1 Pierre Fauchard
Figure 1.2 Bandeau Appliance
Modifications of bandeau appliance
Fauchard's bandeau appliance was further
refined by another fellow French dentist
Etienne Bourdet (1722-1789) who was a dentist
to the King of France in his time. Etienne
Bourdet was also the pioneer of lingual
orthodontics by expanding the arch by metal
framework placed on the lingual side.
Christophe François Delabarre (1787-1862)
CHAPTER 1
another French dentist used swelling threads
and wooden wedges to separate crowded teeth.
Horace H. Hayden (1769-1844) invented bands
with soldered knobs to correct tooth rotation.
In 1803, Joseph Fox invented a modified
version of bandeau appliance that consisted of
silver or gold rim. Silk thread was used as mode
of attachment and force transfer between the
rim and teeth. These silk threads were adjusted
after every three weeks (Figure 1.3a). Blocks of
ivory were used to disocclude the occlusion and
to prevent interference with tooth movement. J.
M. A. Schange (1841) a French dentist wrote the
first book exclusively on orthodontics. He
modified bandeau appliance and took
anchorage by skeletal cribs attached to molars
(Figure 1.3 b). He also invented an appliance to
move malposed teeth within the arch (Figure
1.3 c).Harris in 1850 attached metal caps to
molar and took anchorage from palate in his
expansion appliance (Figure 1.3d)
Development of edgewise appliance
Norman W. Kingsley (1825-1896) and Calvin
S. Case (1847-1923) advocated extraction for
orthodontic purpose. Though Norman W.
Kingsley later abandoned his extraction
philosophy. This extraction philosophy later
influenced the basic design of orthodontics
braces.
Edward Hartley Angle5 (1855-1930) was the
most dominant and influential figure in
orthodontics and is regarded as the “Father of
Modern Orthodontics.” (Figure 1.4). Because
of Edward Angle, orthodontics was recognized
as a distant and separate science6 from general
dentistry. In his initial days of orthodontic
practice Angle advocated extraction in
orthodontics .But latter on the basis of Wolff's
law that “bone in a healthy person will adapt to
applied load” Angle abandoned extraction
treatment. Also another reason to abandon
extraction treatment was failure to get
satisfactory result after extracting 1st maxillary
2
 CHAPTER
Material Perspective of Orthodontic Brackets
2
In this Chapter

Introduction Plastic Brackets

Manufacturing Techniques Plastic Polyoxymethylene brackets
Casting Polyurethane brackets
Milling Composite plastic brackets
Sintering Ceramics Brackets
Metal injection molding (MIM) Aluminum oxide or Alumina (Al2O3) brackets
Ceramic injection molding (CIM) Monocrystalline brackets
Plastic injection molding (PIM) Polycrystalline brackets
Brazing Zirconia brackets
Cold working Calcium phosphate ceramic brackets
Metal Brackets
Stainless steel brackets
Cobalt chromium brackets
Titanium brackets
Precious metal brackets

Introduction stainless steel in edgewise appliances. Ernest

Contemporary orthodontic brackets are
modification of a standard edgewise brackets
developed by Edward H Angle. At the time of
edgewise brackets invention stainless steel
alloy although invented was in the phase of
evolution and orthodontic brackets soldered to
bands were largely made of 14 karat or 18 karat
gold. Rudolf Schwarz 1 was the first to use
13
Sheldon Friel (1888-1970) a pupil of the Angle
(Angle School, 1909) used stainless orthodontic
bands for the first time in 1935.Apart from
stainless steel different other materials have
also been introduced with time to meet the
orthodontists and patient's need. Modern
orthodontic brackets are made up of three
different types of materials which are as follow :
 Material perspective of Orthodontic Brackets
Selection of Stainless steel brackets Table 2.3 Cobalt-Base Wear-Resistant
Stainless steel brackets with good corrosion Alloys
resistance should be selected. Good corrosion
Cr 25-30%
resistance of a bracket is more important than
Mo 7% max
its nickel contents. Ideally SS brackets should W 2-15%
not be used for nickel sensitive patients. C 0.25-3.3%
Conventional SS brackets with softer base Fe 3% max
component and harder slot/wings component Ni 0.5%max
should be preffered.17-4 PH MIM brackets Si 2%
are a good choice for proper torque Mn 1%
expression. New bracket should always be Co Balanced
Where Cr=Chromium, Mo=Molybdenum, W =
the first choice by orthodontists to avoid
Tungsten, C =Carbon, Fe = Iron, Ni=Nickel, Si
corrosion.
= Silicon

Cobalt chromium brackets were introduced in Properties of Cobalt Chromium

mid 1990s as a low nickel alternative to stainless Brackets
steel. Cobalt chromium brackets are fabricated
Friction Resistance
from casting or metal injection molding.
In terms of friction resistance cobalt chromium
Type and Composition of Cobalt based alloys
brackets show comparable30, 31 but slightly less
Cobalt based alloys can be divided into three amount of friction than that of stainless steel
categories .These are: brackets when used with stainless steel wires.
But CoCr brackets offer more friction than
1. Cobalt based wear resistant alloys titanium brackets30 with both stainless steel and
beta titanium wires.
2. Cobalt based high temperature alloys
Corrosion Resistance
3. Cobalt based corrosion resistant alloys
Because of increase chromium contents there is
In these alloys cobalt based wear resistant alloys
less chance of corrosion32 of cobalt chromium
are used29 presently for orthodontic brackets
brackets.
manufacturing .In cobalt based wear resistant
alloys CoCr brackets are made from ASTM F-
75 CoCr where ASTM stands for American
Society for Testing and Materials. The amount
of nickel in this alloy is kept low 29and is up to
0.5 %. Composition of cobalt based wear
resistant alloys is given in table 2.3. A cobalt
chromium bracket is shown in figure 2.19.

Figure 2.19 Nu- Edge® Mini Cobalt Chromium Brackets

by TP orthodontics with 0.5 % nickel.
27
Material perspective of Orthodontic Brackets
Selection
Cobalt chromium alloys have good corrosion
resistance and have a highly polished surface.
But due to less favorable friction properties
with different types of wires, selection of
CoCr brackets over titanium and steel
brackets is a matter of personal choice than
logical basis.
Titanium Brackets
Titanium metal has excellent biocompatibility
and increased corrosion resistance18, 33, 34 so it has
wide ranging surgical application from artificial
heart valves and hip joints to dental implants.
In orthodontics to overcome the release of
nickel from stainless steel brackets which may
cause nickel allergy in some patients, titanium
brackets have been introduced35, 36 as nickel free
alternatives to stainless steel in mid 1990s.
Types of Titanium
From material science perspective titanium has
the following three types:
1. αTitanium
2. β titanium
3. α &β Titanium
Alpha titanium is commercially pure (CP)
unalloyed titanium while the other two types are
titanium alloys.β titanium include Ti-15V-3Cr-
3Sn-3Al alloy while α-β titanium included Ti-
6Al-4V alloy. Alloyed titanium has greater
strength than unalloyed titanium. Chemical
composition of various types of titanium is
given in table 2.4.
Commercially pure (CP) titanium is further
classified into four grades depending upon
degree of impurity, primary oxygen within the
unalloyed titanium. Grade 1CP titanium has the
lowest strength but highest purity, corrosion
resistance and formability as compared to grade
CHAPTER 2
4 CP titanium, which offers highest strength and
moderate formability. Composition of different
grades of CP titanium is given in table 2.5.
Contemporary titanium brackets21, 37 are either
manufactured from alpha titanium grade 2 and 4
or alpha-beta titanium (Ti-6Al-4V).Grade 2 CP
titanium is usually used to make base
component of brackets due to its decreased
strength while the wing component is made
from much harder titanium alloy, the alpha -beta
titanium Ti-6Al -4V.Both these components are
laser welded to make a single unit of bracket. As
explained before for stainless brackets
combination of harder slot/wings part and softer
base part has clinical importance. The softer
base part will allow easy mechanical debonding
while harder slot/wings part will allow
expression of torque.
Due to release of vanadium37from titanium alloy
Ti-6Al-4V which may have biological
hazardous effects some manufacturer make
single unit milled or metal injection molded
bracket from grade 4 CP titanium.
Characteristics of Titanium brackets
Corrosion Resistance
Titanium and titanium alloy brackets have
greater corrosion resistance than stainless steel
brackets. This is due to the presence of thin
passive protective layer of titanium dioxide
over the titanium. This layer of titanium dioxide
is more stable23 than its counterpart layer of
chromium oxide on stainless steel. The
composition of titanium dioxide layer which is
also called rutile is given in table 2.6.
Brackets in which two parts are joined together
by welding have greater chances of galvanic
corrosion than one piece milled or MIM
brackets. A titanium bracket is shown in figure
2.20.
28
Material perspective of Orthodontic Brackets
than conventional ceramic brackets and these
brackets don't cause enamel damage.
Selection of ceramic brackets
Ceramic brackets are usually selected for
patients who have aesthetic concerns. Due to
iatrogenic damages associated with ceramic
brackets they should only be selected when
clinicians have proper knowledge of
mechanics and proper instrumentation for
debonding is available.
Monocrystalline brackets give better
aesthetic than polycrystalline brackets but are
more expensive and fracture easily and more
with time. Zirconia brackets are rarely used in
contemporary orthodontics. Calcium
phosphate ceramics is manufactured by only
one company and not much is known about
these brackets so selection of these brackets is
a personal preference.
References
1. Hotz RP. The changing pattern of European orthodontics. Br J Orthod
1973; 1:4-8.
2. Matasa C. Characterization of used orthodontic brackets. In: Eliades
G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials in Vivo:
Aging and Related Phenomena. New York, NY: Quintessence;
2003:141–156.
3. Zinelis S, Annousaki O, Makou M, Eliades T. Metallurgical
characterization of orthodontic brackets produced by Metal Injection
Molding (MIM). Angle Orthod. 2005 Nov;75(6):1024-31.
4. Floria G, Franchi L. Metal injection molding in orthodontics.Virtual
J Orthod. 1997:2.1.
5. Coley-Smith A, Rock WP. Distortion of metallic orthodontic brackets
after clinical use and debond by two methods. Br J Orthod. 1999
Jun;26(2):135-9.
6. Zinelis S, Annousaki O, Makou M, Eliades T. Elemental composition
of brazing alloys in metallic orthodontic brackets.Angle Orthod.
2004;74:394–399.
7. Matassa C. Characterization of used orthodontic brackets. In:
Eliades G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials In
CHAPTER 2
Vivo: Aging and Related Phenomena. New York, NY: Quintessence;
2003:141–156.
8. Brockhurst PJ, Pham HL. Orthodontic silver brazing alloys.
AustOrthod J. 1989;11:96–99.
9. Mockers O, Deroze D, Camps J. Cytotoxicity of orthodontic bands,
brackets and archwires in vitro. Dent Mater. 2002;18:311– 317.
10. Grimsdottir MR, Hensten-Pettersen A. Cytotoxic and antibacterial
effects of orthodontic appliances. Scand J Dent Res. 1993;101:
229–231.
11. Grimsdottir MR, Hensten-Pettersen A, Kullmann A. Cytotoxic effect
of orthodontic appliances. Eur J Orthod. 1992;14:47–53.
12. Oh KT, Choo SU, Kim KM, Kim KN. A stainless steel bracket for
orthodontic application. Eur J Orthod. 2005 Jun;27(3):237-44.
13. Feldner JC, Sarkar NK, Sheridan JJ, Lancaster DM. In vitro torque-
deformation characteristics of orthodontic polycarbonate brackets. Am
J Orthod Dentofacial Orthop. 1994 Sep;106(3):265-72.
14. Flores DA, Choi LK, Caruso JM, Tomlinson JL, Scott GE, Jeiroudi
MT. Deformation of metal brackets: a comparative study. Angle Orthod.
1994;64(4):283-90.
15. Maijer R, Smith DC. Corrosion of orthodontic bracket bases. Am J
Orthod. 1982 Jan;81(1):43-8.
16. Creekmore TD, Kunik RL. Straight wire: the next generation. Am J
Orthod Dentofacial Orthop. 1993 Jul;104(1):8-20.
17. Arici S, Regan D. Alternatives to ceramic brackets: the tensile bond
strengths of two aesthetic brackets compared ex vivo with stainless steel
foil-mesh bracket bases. Br J Orthod. 1997 May;24(2):133-7.)
18. Eliades T, Athanasiou AE. In vivo aging of orthodontic alloys:
implications for corrosion potential, nickel release, and
biocompatibility. Angle Orthod. 2002 Jun;72(3):222-37.
19. Schiff N, Dalard F, Lissac M, Morgon L, Grosgogeat B. Corrosion
resistance of three orthodontic brackets: a comparative study of three
fluoride mouthwashes. Eur J Orthod. 2005 Dec;27(6):541-9.
20. Oh KT, Choo SU, Kim KM, Kim KN. A stainless steel bracket for
orthodontic application. Eur J Orthod. 2005 Jun;27(3):237-44.
21. Eliades T, Zinelis S, Eliades G, Athanasiou T. Characterization of
as-received, retrieved and recycled stainless steel brackets. J Orofac
Orthop. 2003;64:80–87.
22. Hunt NP, Cunningham SJ, Golden CG, Sherif M. An investigation
into the effects of polishing on surface hardness and corrosion of
orthodontic archwires. Angle Orthod. 1999;69: 433–440.
23. Brantley WA. Orthodontic wires. In: Brantley W, Eliades T, eds.
Orthodontic Materials: Scientific and Clinical Aspects. Stuttgart,
Germany: Thieme; 2001:95.
24. Eliades, T., Eliades, G., Brantley, W.A. (2001). Orthodontic
brackets, in: Brantley, W. A., Eliades, T. (Eds.), Orthodontic Materials:
scientific and clinical aspects Thieme, Stuttgart, 146-147.
25. Platt JA, Guzman A, Zuccari A, Thornburg DW, Rhodes BF, Oshida
Y, Moore BK. Corrosion behavior of 2205 duplex stainless steel. Am J
Orthod Dentofacial Orthop. 1997 Jul;112(1):69-79.)
26. Eliades T. Orthodontic materials research and applications: part 2.
38
 CHAPTER
Selection of Bracket Base
3
In this Chapter

Bracket Base Retention Design Precious metal Brackets

Stainless steel Brackets Plastic Brackets
Chemical Retention
Mechanical Retention
Mechanical Retention
Perforated bases
Combination of chemical and mechanical
Mesh type bases
retention
Integral bases
Ceramic Brackets
Photoetched bases
Chemical Retention
Microetced bases
Mechanical Retention
Metal sintered bases
Micromechanical retention
Laser structured bases
Ceramic brackets with prestressed base
Plasma coated brackets
Combination of different retention designs
Chemical Retention
Bracket base surface area
Stainless steel brackets and Cross
infection Bracket base shape

Titanium Brackets Bracket identification marks

Cobalt Chromium Brackets Torque in the Base

The base component of orthodontic brackets Bracket Base Retention Design

makes possible the attachment of a bracket to
the tooth. This attachment must be strong
enough to transfer orthodontic forces from the
wires to the teeth, withstand masticatory loads
and should easily be removed at the end of
treatment.
Orthodontic brackets are attached to teeth or
other supporting structures of porcelain, metal,
composite and acrylic through various
commercially available adhesives. To increase
retention of bracket bases to adhesives various
chemical, mechanical or combination of both
retention designs have been added to the bracket
base. Though the exact manufacturing details

41
Selection of Bracket Base
are not provided from the manufacturer some
basic informations are available.
1) Stainless steel Brackets
Most orthodontic brackets used in
contemporary orthodontics are made of
stainless steel which mostly uses mechanical
retention because stainless steel doesn't form
any chemical union with adhesives. Stainless
steel bracket base is either integral part of the
bracket or is made separately and then joined
to the main body of the bracket by brazing or
welding (Figure 3.1).Different types of
stainless steel bracket bases are given in the
following text.
1. Perforated bases
Brackets with perforated bases are one of
the oldest bracket designs for mechanical
retention1 (Figure 3.2). The original metal
pad consists of one row of peripheral
perforation. The basic idea was to allow
greater penetration and free flow of
adhesive cement through the bracket base
to increase the bond strength. But
unfortunately excessive adhesive coming
out of the holes of bracket base was
potential plaque retention area which get
discolored with time so raised esthetic
concerns by the patients and don't provide
superior retention as compared to other
designs2,3,4,5,6. Because of these
disadvantages perforated bracket bases
went into disuse.
2. Mesh type bases
Mesh type bases have replaced perforated
bases and are most popular type used in
contemporary orthodontics. Following
different terms are used for mesh based
bases in literature and by manufacturer
owing to slight variation in mesh design.
CHAPTER 3
a) Foil mesh base
b) Gauze or woven mesh base
c) Mini mesh base
d) Micro mesh base
e) Optimesh base
f) Ormesh base
g) Laminated mesh base
h) Single mesh base
I) Double mesh base
j) Supermesh base
Description of some important mesh
designs is as follows.
a) Foil mesh base
In orthodontic literature the term foil
mesh base is used interchangeably with
gauze or woven mesh base. But there are
slight differences in the manufacturing
design between foil mesh and woven
mesh base (Figure 3.3) .Foil mesh bases
are more esthetic and hygienic than
perforated bases because of their smooth
covered surface 2, 3, 7, 8 . Foil and woven
mesh bases provide superior retention
than perforated bases and many other
bracket base designs used in
contemporary orthodontics 4, 7, 9. Foil mesh
bases can be simple or microetched,
photoetched or plasma coated by the
manufacturer. The foil mesh is either
brazed or welded on to the bracket base.
The spot welding of foil mesh to bracket
base results in decreased base surface
areas and so bond strength 2, 4, 10 therefore
spot welding have been taken over by
silver based laser welding 11.
Foil mesh bases can be single mesh or
double mesh.
42
Selection of Bracket Base
CHAPTER 3
lower bond strength than high filled
adhesives.
Another alternative is to use glass ionomer or
resin modified glass ionomer41 cements
(RMGIC) with ceramic brackets as glass
ionomer cements have shown to have
decreased 42,43 but clinically acceptable bond
strength32, 44, 46 than composite resins . Though
bond failure of glass ionomer cement is
present at enamel adhesive interference but
no enamel damage is reported 44, 45 with this
adhesive cement because RMGIC has lower
Figure 3.27 Greater the retentive bracket base surface
bond strength. area greater would be the bond strength.If the base surface
area is not retentive then no matter how much wider is the
Glass ionomer cement also has the added bracket the bond strength will remain minimum or
advantage of fluoride release and so it bracket will fail to bond. The above brackets have
manufacturing faults which have increased the surface
prevents enamel decalcification and area but area is not retentive. So instead of favoring bond
formation of white spot lesions during strength the area can act as plaque reservoir and may lead
to development of white spot lesion under the bracket
orthodontic treatment. base.
of increasing or decreasing the bracket base
Selection of ceramic bracket base surface area. Proffit 48 purposed that width of
Ceramic bracket base using only chemical the bracket shouldn't be more than half of the
retention is neither marketed nowadays nor width of the tooth while MacColl49
should be used due to risk associated with recommended that bracket base surface area
enamel damage. All other commercially should be around 6.82 mm2. Usually the
available ceramic brackets are acceptable for manufacturer of brackets keep a larger base
orthodontic purpose as long as suitable or area to give better bond strength and rotational
recommended debonded techniques are control .
used. My personal recommendation after Clinical implication of Bracket base
going through all the available literature and surface area
personal experience is that ceramic brackets
with plastic base or prestressed base should Increase Bracket base surface area
be used as it debond safer than other base
Advantages
types.
This has the following advantages:
Bracket base surface area
1. Increased bond strength. This is helpful
An important technical specification that affects
especially in case of plastic brackets which
the bond strength of orthodontic bracket is its
offer less bond strength than other type of
base surface area. Most orthodontists presently
brackets. Clinically acceptable bond
use twin brackets. The surface area 26,47 of these
strength50 is around 5.9 to 7.8 Mpa but bond
brackets range from 12.5mm2 to 28.5 mm2.
strength shouldn't exceed 51 than 13.5Mpa to
Greater the retentive bracket base area greater
avoid enamel damage.
would be the bond strength and vice versa
(Figure 3.27). But there is practical limitations
56

Selection of Bracket Slot
In this Chapter
Introduction
Type of bends for 3 dimensional tooth
movements
Dimensions of Edgewise slot
Accessary slots
Tip edge brackets
Advantages of 0.018” slot
Advantages of 0.022” slot
Introduction
Slot is part of the bracket in which the wire is
engaged to express the builtin prescription of
the bracket. The slot of the bracket has seen
much evolution with time. It started from
occlusal opening slot in Angle ribbon arch
appliance to gingival opening slot in Begg
appliance and front opening slot in Angle
edgewise system. In contemporary orthodontics
edgewise slot is universally accepted .Vertical
slots are still used in some bracket series but
usually as an accessary slot.
When bracket slot was first introduced they
were simple openings in which a bended wire
incorporating all the necessary tooth
movements was inserted. The brackets having
such passive slots were called standard
brackets. With time 1st, 2nd and 3rd order bends
61
CHAPTER
4
Bidemensional mechanics
Morphology of the brackets
Gingival offset brackets
Slot modifications to reduce friction
Ligation: The fourth wall of Bracket slot
Tie Wings of the brackets
were incorporated in brackets to produce
respective tooth movements 1. Before going into
the details of slot a brief description of these
bends and associated movements are given.
Type of bends for 3 dimensional tooth
movements
First order bends (In or out bends)
First order bends are given to accomplish first
order tooth movements which are in a
labiolingual or buccopalatal direction. 1st order
bends can be made in horizontal direction in the
wires such as the step bends, or are
accommodated in the brackets (Figure 4.1). As
different teeth in the arch have different width
these bends made in the wire or built into the
bracket are used to accommodate different tooth
width. Vertical step bends that don't change the
Selection of Bracket Slot
CHAPTER 4
angulation of the teeth are also considered as 1st
order bends. First order bends in brackets are
incorporated by increasing the prominence of
the bracket.

A B

C
Figure 4.1 A. A line showing different prominence of the teeth in natural dentition due to difference in width of the teeth. B.
Wire bending done to compensate 1st order tooth movement. This type of wire bending is usually done in conventional edgewise
system. C. First order bends built within the bracket. This is evident with different prominence of the brackets in upper arch.

Clinical Notes Second Order Bends (Tip or Angulation

The clinician should always use same
companie's brackets. If a bracket is
debonded either the bracket should be
recycled and reused or a new bracket of
same company should be used. Different
companies have different prominence of
the brackets(Figure 4.2). So using different
companie's brackets will result in first
order tooth position problems in a finished
case.
Figure 4.2 Maxillary lateral incisor brackets from two
different manufacturers having same builtin prescription.
The height or prominence of these brackets is different.
bends)
These bends are made in vertical plane in the
wire to accommodate tooth angulation and root
parallelism. Second order bends can also be
incorporated in the brackets by placing the slot
at an angle to the base (Figure 4.3).
Clinical Notes
Different bracket prescription have
different builtin tip. An experienced
clinician can use combination of brackets
from different prescription provided that
they have the same prominence. It is a good
practice to use brackets of single
manufacturer while altering the
prescription.
62

Selection of Auxiliary and convenience features
In this Chapter
Auxiliary features
Power arms
Accessary slots
Convenience features
Vertical Mid Scribe line
Shape of brackets
Bracket identification
Many auxiliary and convenience features are
added to the brackets and tubes to make
treatment mechanics easier and convenient.
Auxiliary features
Power arms
Power arms are added to the brackets on its
gingival side to control root position during
translation of the teeth. The reason for making
power arms on gingival side is to bring the force
application closer to the center of resistance of
the teeth. Andrew1 proposed that for effective
control of root position during translation, the
mesiodistal length of bracket plus height of
power arm should be equal to distance from the
slot point to tooth center of resistance (Figure
5.1). As root of canine is longer than other teeth
so power arm of canine tooth would also be
77
CHAPTER
5
longer than other teeth. But there are practical
limitations in increasing the width of bracket
and height of power arm. A wider bracket will
decrease interbracket distance so increasing the
wire stiffness and thus greater time would be
needed in alignment and leveling. Also a wider
bracket will be more noticeable, thus increasing
aesthetic concerns of the patients. The height of
power arm is limited by soft tissue present
around the tooth as long power arm will
impinge on the gingiva either making ideal
bracket placement difficult or leading to
gingival hyperplasia due to soft tissue
impingement.
Advantages of power arm
1. Power arm makes the application of force
delivery system such as springs, power
chains, and elastics much easier and close to

Selection of Bracket Prescription
In this Chapter
Introduction
Andrew Prescription
Key I: Interarch Relationship
Key II: Crown Angulation or
Mesiodistal Crown tip
Key III: Crown inclination or Torque
Key IV: Absence of Rotations
Key V: Tight Contact points
Key VI: Flat Occlusal plane or Curve
of Spee
Limitations of Andrew prescription
Introduction
Angle introduced edgewise brackets to have a
better control on three dimensional positions of
the teeth. But the problem in these brackets was
that complex wire bending was required to
control the tooth position. Andrew 1,2 modified
the standard edgewise brackets developed by
Angle by introducing tip, torque and in& outs in
his preadjusted edgewise brackets .The amount
of tip torque and in & outs built within
preadjusted brackets were called prescription of
the brackets. After Andrew a lot of orthodontists
introduced their versions of bracket prescription
sometimes based on studies and many times
based on clinical experience. Each clinician
83
CHAPTER
6
Different Bracket prescriptions
Roth Prescription
Limitations of Roth Prescription
MBT Prescription
Alteration of prescription
who advocated a specific prescription also
advocated specific mechanics during the course
of treatment for expression of the prescription.
In medicine to treat a disease properly, the right
diagnosis should be made. That helps the
physician to advise the right prescription of
drug .Same is true in orthodontics. After making
a right diagnosis and treatment planning of a
malocclusion the right prescription should be
used. Using the right prescription, simplify the
treatment mechanics which will save
considerable chairside time. In most cases there
would be minimal or no need of wire bending
during the course of orthodontic treatment.

Selection of Bracket Prescription
A detailed description on evolution of different
types of orthodontic prescriptions is given in
this chapter. Main focus is given to the
development of Andrew prescription because
all other prescriptions are either variations or
based on Andrew's data.
Andrew Prescription
Lawrence F. Andrew1 introduced the first
preadjusted brackets where all the bending's
needed in archwire in standard edgewise
bracket system were built within the brackets. It
was proposed that this appliance does not
require wire bending during treatment hence the
name Straight wire appliance (SWA) was given
to it.
Andrew after a study on 120 non-orthodontic
ideal occlusion dental casts concluded that in
order to attain ideal occlusion some
characteristics must be present within the
occlusion. These characteristics were divided
into six keys. Based on these 6 keys Andrew
developed his prescription of brackets, so that
using this bracket prescription no wire bending
would be required during treatment and at the
end of treatment, all the six keys to normal
occlusion would be attained.
Andrew apart from studying these non-
orthodontic ideal occlusion dental casts also
studied 1150 orthodontic treated cases so that
his prescription could also address some of the
problems not found in ideal occlusion e.g.
Extraction cases where molar relation may
deviate from class I relationship.
Most of the modern preadjusted brackets are
minor modification of Andrew straight wire
appliance. To give a better understanding of
prescription so that clinician can make an easy
selection of brackets a complete description of
Andrew six keys to normal occlusion and how
prescription components evolve from each key
is given. Details on how a prescription in
bracket is transferred to a tooth are also given
CHAPTER 6
with each key so that the readers can have a clear
knowledge of effects and limitations of a
prescription.
Key I: Interarch Relationship
Key I as originally proposed by Andrew 1 was
molar relationship. But in 1989 Andrew2
changed the key from molar relationship to
interarch relationship. Interarch relationship is
broader and more definite description of
occlusal relationship than relying on molar
relations only. Interarch relationship as key 1 is
considered in this text because it will clear the
reader's mind about the basis and need of
prescription.
Key I have seven parts 2 which are given below:
Part 1
The mesiobuccal cusp of the maxillary first
permanent molar fits in the groove between the
mesial and middle buccal cusps of the
mandibular first permanent molar.
Part 2
The distal marginal ridge of maxillary 1st molar
occludes with mesial marginal ridge of the
mandibular 2nd molar.
Previously1 this relation was. "The distal
surface of the distobuccal cusp of maxillary 1st
molar made contact and occluded with the
mesial surface of the mesiobuccal cusp of the
mandibular second molar." The closer these
two surfaces of maxillary 1st and mandibular
2nd molar contact and occlude , the better
would be the opportunity for normal
occlusion.
Part 3
The mesiolingual cusp of the maxillary 1st
permanent molar occludes in the central fossa of
mandibular 1st permanent molar.
84

Part 4
The buccal cusp of the maxillary premolars
have cusp embrasure relationship with
mandibular premolars. The maxillary 2nd
premolar buccal cusp lies between embrasure of
mandibular 1st molar and mandibular 2nd
premolar. Buccal cusp of maxillary 1st premolar
lies in the embrasure between mandibular 1st
and 2nd premolars.
Clinical Notes
To check if a case has attained Key I,
always judge from buccal aspect clinically
and both from buccal and lingual aspects on
the dental cast.
Part 5
The lingual cusp of the maxillary premolars has
a cusp fossa relationship with mandibular
premolars.
Part 6
The maxillary canine tip lies slight mesial to the
embrasure between mandibular canine and 1st
premolar.
Part 7
The maxillary incisors overlap the mandibular
incisor with their dental midlines coinciding.
A description of key I is given in figure 6.1.
A B
Figure 6.1 An ideal occlusion case meeting all the criteria of key I . A .Buccal aspects . B. Lingual aspects
85
Selection of Bracket Prescription
Incorporating key I into bracket
prescription
Key I is interrelated with next 5 keys to normal
occlusion. Key I will only be achieved when the
rest of the keys have been achieved too.
To attain key I, a preadjusted bracket should
have built in 1st, 2nd and 3rd order bends and
brackets should be optimally placed on the
tooth. Only description of 1st order bends and
how and why they are included in the
prescription would be given here. The rest
would be discussed in their respective keys.
To incorporate the right amount of 1st order
bends with in his prescription Andrew 2
measured the facial prominence of each tooth
within the arch of an ideal occlusion
case .This was done by measuring the distance
from the embrasure line to most prominent
facial point of each tooth, where embrasure
line is imaginary line at crown mid transverse
plane that connects the facial portion of
contact areas of a single crown or all the
crowns in an arch when the crowns are
optimally placed. Figure 6.2 and table 6.1.
From the figure 6.2 and table 6.1 it is clear that in
maxillary arch lateral incisors have least facial
prominence while in mandibular arch both
central and lateral incisors have least facial
prominence. These values were built within the
base or stem of the brackets so that at the end of
leveling and alignment all the brackets slots
 CHAPTER 6
Selection of Bracket Prescription

have same level of prominence while all the

teeth have the prominence value found in table
6.1.

How it works?

To build the right amount of prominence within

the brackets, Andrew incooperated a simple rule
that the distance between most prominent facial
point of the crown and the embrasure line is
inversely proportional to the distance between
slot point and most prominent facial point of
crown in mid transverse plane.(Figure 6.3A) .
This means that if a tooth has less facial
prominence of crown it would have increased
A
bracket prominence (Figure 6.3B&C). The slot
point is the mid of the bracket slot in all three
planes of space. For the ease of simplicity
since we are viewing the tooth from lateral
side so base of the slot instead of slot point
would be used in this text.

So in maxillary arch lateral incisor bracket

B found to be less prominent than central incisors
Figure 6.2 Facial prominence of teeth in the arch
.The distance between embrasure line and most prominent
facial point of each tooth is the prominence of the tooth. A.
Average maxillary arch crown prominence. B. Average
mandibular arch crown prominence. These prominence
values are incorporated into the brackets by varying the
distance from base of slot to base of brackets.
would be the most prominent bracket in mid
transverse plane. When such a bracket is placed
on the tooth a palatal force is expressed by the
flexible wire on this tooth as compared to
neighboring teeth which absorb reactionary
labial or buccal force because less prominent
brackets are placed on them . So eventually on
heavy wires maxillary lateral incisor crowns are
and canine crowns while all the brackets slot
point or slot bases are at same level of
prominence .
In Andrew's prescription (table 6.2) of fully
programmed standard brackets, maxillary

Table 6.1.Crown prominence in maxillary and mandibular arch

Teeth Central Lateral Canine 1stpremolar 2ndpremolar 1st Molar 2nd Molar
incisors incisors
Maxillary Arch 2.1mm 1.65mm 2.5mm 2.4mm 2.4mm 2.9mm 2.9mm
Mandibular arch 1.2mm 1.2mm 1.9mm 2.35mm 2.35mm 2.5mm 2.5mm

86
 CHAPTER 6
Selection of Bracket Prescription

B
Figure 6.43. A. Improper tip of central incisors and lack of torque in lateral incisors. To compensate it canine was moved
forward leaving poor contact point between canine and premolar. B. A case with good occlusal results and proper contact points
due to proper tip, torque, prominence and lack of rotation characteristics.

A B
Figure 6.44 A. increased curve of spee. If curve of spee is increased or deep, there would be less space for upper incisor.
Occlusion would be disturbed both anteriorly and posteriorly. B. Reverse curve of spee. If the curve of spee is decreased or reversed
in lower arch than there would be excessive space in the upper arch.

increased at the end of treatment.
Clinical implication of Key VI
Nothing is built within bracket prescription to
accommodate key VI because it is more related
with position of the brackets on the teeth.
Accomplishing this key is very important for a
good occlusal outcome. Andrew found that
nonorthodontic dentition has flat to slight curve
of spee and preposition of flat curve of spee was
given to accommodate natural tendency of
curve of spee to increase with age due to growth
of lower jaw and its growth rotation. Banding or
bonding the second molars also help in leveling
of curve of spee .Usually leveling 1mm of curve
of spee 37 require less than 1mm of space. A
description of curve of spee is given in the
figure 6.44.
Limitations of Andrew prescription
Large inventory
In Andrew system to deal with different types of
arch discrepancies there are 12 maxillary and 11
mandibular sets, which are combination of five
different types of brackets .These are
118

S – Standard Brackets
T1 – Minimum Translation Brackets
T2 – Medium Translation Brackets
T3 – Maximum Translation Brackets
T4 – Maxillary Molar tubes or bands for Class
II&III
Andrew gave such a big inventory to make the
treatment more individualized. But
unfortunately this became one of the biggest
limitations of his prescription. Making so many
different types of brackets means that there is
need for more machinery, more space, more
work force and so more finances needed for the
manufacturer. Also when there are so many
different types of brackets, more time and
education is needed for the orthodontist to get a
better understanding for making the right choice
in each case. So when there is no Magic formula
available, orthodontics will remain only for
professional orthodontists. This means loss of
valuable clientage for the manufacturers.
Unfortunately the problem in orthodontics is
that if the orthodontist is customizing treatment
Table 6.12
answers. Do we need to accommodate wagon
wheel effect in class I incisor torque as it is
natural position of the incisors within the arch?
If wagon wheel effects occur due to anatomy of
area and our treatment mechanics, why not the
tip is decreased in the prescription in case of
class II incisor torque and increased in case of
class III incisor torque?
119
Selection of Bracket Prescription
by bracket prescription or by wire bending he is
wasting his time but if the manufacturer is
customizing brackets it's an innovation and you
have to pay for that innovation.
For the orthodontist keeping a large inventory at
orthodontic office means there is need for more
financial resources and more office space. This
is obviously against the core rules of good office
financial management. So unfortunately the
very benefit of Andrew prescription to provide
individualized treatment to some extent became
the most limiting factor of its wide acceptance.
Tip and Torque
Both tip and torque values placed in Andrew
prescription are slight different from Andrew
original findings of normal occlusion 2.
Tip in Andrew Straight wire appliance and
actual tip from his study are given in table 6.12.
There is overall increased in tip in SWA as
compared to Andrew original findings. For
change in tip values it is generally presumed that
Andrew made the changes to accommodate
wagon wheel effects. There are some questions
in this regard that for the time being have no
Torque values were also changed by Andrew to
some extent than original norms (table
6.13).Overall there is decrease in torque values
in SWA as compared to original findings. After
going through Andrew work my understanding
is that Andrew changed the upper incisor torque
values to incorporate finding of his unpublished
100 cases cephalometric study. For example in

Selection of Bracket Prescription
Table 6.13
original Andrew's norms the maxillary central
incisor class I torque was 6.11° while the lateral
incisor torque was 4.42°.In cephalometric study
Andrew found that there is always 4° difference
between maxillary central and lateral incisor
torque. So I presume that he changed the torque
of central to 7° and lateral to 3° to make that
study count. Other values were changed either
to incorporate clinical experience or to round off
values for ease of standardization.
Apart from this, Andrew also didn't take in
consideration various factors that affect the
expression of tip and torque especially the play
of the wire. This is because Andrew advocated
full dimension wires at the end of treatment for
expression of entire builtin tip and torque.
Because of their increased stiffness use of full
dimension wires have been abandoned and so
the problem started with expression of the
prescription.
Counter-rotation
Andrew incorporation of counter rotation into
the slot was also not appreciated by many.
Though effective during space closure but if the
orthodontist remain on a heavier wire for long
time using effective ligation of wire to
consolidate tooth position or torque correction
after space closure the teeth having counter
rotation brackets will become rotated due to
expression of prescription .
So Andrew prescription presents a dilemma for
clinician in extraction cases. Moving to heavier
CHAPTER 6
wire for better tip and torque expression as
Andrew didn't accommodated wire play in his
prescription but such wire will cause counter
rotation expression. Many clinicians who
favors counter rotation in brackets for
extraction cases and also have included counter
rotation in their own prescription advocate that
as relapse is inevitable so the rotation is part of
over correction and it will eventually be
relapsed during the settling phase. But the
practical problem a young orthodontist face
today is that he has to display his finished case
in exam and complete the settling phase with
elastics or wire bending than going on natural
settling with retainers. It is difficult to settle
teeth into occlusion when they are rotated.
Correction of rotation will leave space in the
arch and there are many different retainers of
modern day such as fix retainers and vacuum
formed retainers that don't allow settling to the
extent as Hawley retainers do.
So orthodontists are left with two choices when
using counter rotation brackets at the end of
treatment. Replace bracket with standard
brackets or resort to wire bending.
Limitations in Mechanics
As expression of bracket prescription depend
upon what mechanics one uses, many clinicians
who later made their own prescription pointed
out some mechanics flaws present in Andrew
philosophy for case treatment. These were
1) Anchorage loss
120

As tip built into Andrew appliance was more
than what Andrew found in his original
research so this increased tip put strain on
posterior anchorage and also cause anterior
anchorage loss at the initial stages of
treatment. Anchorage control was also
difficult in extraction case.
2) Leveling Curve of Spee
Many clinicians also didn't agree with
Andrew philosophy of leveling curve of spee
with compensatory curves in wires in
maxillary arch and reverse curves in wire in
mandibular arch.
3) Roller coaster effects
In early years of SWA class II elastics were
used for sliding mechanics. In order to
overcome friction heavy forces were used.
Increased anterior tip, vertical component of
elastics and heavy forces resulted in
deepening of anterior bite and opening of
lateral bite. This effect was called Roller
Coaster Effect (Figure 6.45).
Figure 6.45 Roller coaster effects and anterior deep bite
and lateral open bite.
4) Root parallelism
Andrew measured tip values by using long
axis or facial axis of clinical crown and not
the whole tooth. There is always some degree
121
Selection of Bracket Prescription
of variation32 between long axis of clinical
crown and long axis of the tooth. Placing the
bracket just by keeping in mind the long axis
of clinical crown will result in poor root
parallelism in many cases. Also due to
increase tip built into Andrew prescription
there are chance of root approximation of
teeth especially between maxillary canines
and premolars.
5) Bracket Height
Andrew advocated bracket placement at mid
of long axis or facial axis of clinical crown
also called LA point(long axis point) or FA
point(facial axis point). Judging the FA point
or LA point on a tooth was a matter of clinical
experience. Some clinicians3, 38 didn't agree
with validity of placing bracket at the FA
point to get an ideal occlusion while others39, 40
advocated that there are greater chances of
error in placing bracket on FA point and gave
fixed distance from incisor edge and
suggested using special gauges for bracket
placement. Effects of change in height on
bracket prescription have been discussed
before.
Because of these limitations different types of
bracket prescription were put forward with
time. Whether these new bracket prescriptions
solved any practical limitation of Andrew
prescription is still debatable but there is a
general consensus that they solved the problem
of manufacturers and general dentists in the
form of “A Single Fairytale Bracket Set for All
Types of Malocclusion”.
Different Bracket prescriptions
With time so many clinicians put forward their
own prescriptions of brackets .For effective use
of these prescriptions many of them also
advocated their own treatment mechanics and
bracket position on teeth. Even some clinician
went to the extent to recommend certain
commercial brands of wires for effective
 Selection of Bracket Prescription
Table 6.15 Mandibular arch values of different prescriptions

Mandibular Central Lateral Canine 1 st 2 nd 1 st Molar 2 nd M olar

Arch incisor incisor Premolar Premolar

Torque° Tip° Torque° Tip° Torque° Tip° Torque° Tip° Torque° Tip° Torque° Tip° Offset° Torque° Tip ° offset

Alexander -5 +2 +5 +6 –7 +6 –7 0 –9 0 –10 0 0 0 0 5

Begg 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 6

Burstone –1 0 –1 0 – 11 +6 –17 0 –22 0 – 27 0 5 –27 +2 6

Damon -3 2 -3 +4 +7 +5 -12 +4 -17 +4 -28 +2 2 -10 0 5

(standard
torque)

Hasund 0 0 0 +5 0 +5 –10 +2 –15 +2 -22 +4 0 – 25 +2 6

Hilgers –1 0 –1 0 +7 +6 –11 0 –17 0 –25 0 7 –25 0 6

Ricketts®– 0 0 0 0 +7 +5 -7ex 0° -7 ex 0 –22° –5 12 –27 0 16

0 n- -14 n-
IV. ex ex
Dimension
Ricketts® 0 0 0 0 +7 +5 0 0 0 0 0 0 0 0 0 0
Standard
Standard 0 0 0 0 0° 0 0 0 0 0 0 0 0 0 0 0
Edgewise
Tweed 0 0 0 0 0 0 0 0 0 0 0 0 0/6 0 0 0/6

diminution of force. brackets such as double and triple tubes,

addition of hooks for ease of mechanics.
III. Leveling of curve of spee to some extent by
placing anterior brackets more incisal. How Roth Made this Prescription?

IV. More torque in anterior brackets to
accommodate torque loss by wire play.
V. Super torque brackets for rapid correction of
torque in class II div2 cases.
VI. Roth proposed a new archform called Tru-
Arch to be used with his prescription. Roth
advocated selection of archwire is important
as it effects the rotational position of teeth.
Wider the archform more positive torque
would be expressed and vice versa. Roth
archform was most prominent and wide at
mesiobuccal cusp of the first molars.
VII. Different translation philosophy.
According to Roth tipping of the teeth to some
extent is accepted on round wires.
VIII. Many auxiliary features were added to
123
Dr. Andrew in one of his articles42 commented
on origin of Roth prescription. According to
Andrew, Dr. Roth found that a high percentage
of his cases can be treated by using Andrews'
class III incisor torque brackets for maxillary
arch and class I incisor torque brackets for
mandibular arch. For buccal segment Roth used
Series 1-C and Series II-Classic. Where series
1-C was given in all 1st premolar extraction
cases where both maxillary and mandibular
canines are given maximum translation series
brackets and both arches 2nd premolars are given
minimum translation series brackets while
molars are given standard SWA. Series II-
Classic brackets were used in case of extraction
of maxillary 1st and mandibular 2nd premolars
because of class II molar relationship. In this
series maxillary canines and lower posterior
 CHAPTER 6
Selection of Bracket Prescription

Table 6.16. Roth Prescription

Teeth Central Lateral Canine 1st & 2nd Premolar 1st &2nd Molar
incisors incisors

Torque Tip Torque Tip Torque Tip° Rotatio Torque Tip Rotation Tip Torq Rotation°
° ° ° ° ° n° ° ° ° ° ue°

Maxillary +12 +5 +8 +9 -2 +13 2MR -7 0 2 MR 0 -14 14DR/0°

Arch
Class II

Mandibul -1 +2 -1 +2 -11 +7 2 DR -17 -1 4DR -1 -30 4DR

ar arch P1&

-22
P2

Where MR=Mesial Rotation to counter distal translation. DR= Distal rotation to counter mesial
translation. P1 = 1st Premolar P2 =2nd Premolar , Class II= Molar Class II in cases where
only upper 1st or 2nd premolars are extracted .Reference for above Table 3, 40.

are given maximum translation series brackets Canines

and lower canine and upper posterior are given
minimum translation series brackets.
Roth prescription is given in table 6.16.
These comments by Andrew about Roth
prescription were made in 1976 and in the same
year Roth43 wrote an article about his 5 year
practice changing experience with Andrew
prescription. Unfortunately he didn't reveal
anything about his specific selection of brackets
from Andrew's work. It was in 1987, that Roth3
published his prescription and given
justification for it. That prescription is far
different from Andrew's comments. The only
comment true is about maxillary and
mandibular incisor tip and torque. A personal
review of literature by this author couldn't find a
prescription by name of Roth that matches
Andrew's comments. The first published Roth
prescription is given in table 6.16.
An evaluation of origin of this prescription is
given.
Maxillary Arch.
The maxillary canine tip is taken from
minimum translation series brackets made for
distal translation. Canine torque was Roth
personal calculation of torque to accommodate
wire play. Canine counter rotation feature was
also taken from Andrew distal translation group
in minimum translation series brackets.
Premolars
Both 1st and 2nd premolar tip was taken from
minimum translation series brackets requiring
mesial translation. Premolar torque was taken
from Andrew standard SWA. Counter rotation
feature was taken from minimum translation
series brackets for distal translation.
Molars
Both 1st and 2nd maxillary tip was selected from
Andrew Class II molar tip. Torque of molars
was selected from Andrew medium translation
series brackets. Counter rotation values for
molars were taken from medium translation
series for mesial translation.
124

Controversy
In maxillary arch both canine and premolars
brackets have minimum translation features
builtin. If one tooth need to be minimally
translated in extraction space in most of the
cases than the other tooth need to be maximally
translated to close the extraction space.
Premolars have counter rotation feature for
distal translation. It's a common finding that in
most of our cases premolars needed to be
translated mesially than distally. Also premolar
counter rotation feature don't correlate well
with molar except in 2nd premolar extraction
cases where molar need mesial translation and
1st premolar need distal traction.
The molar tip is meant for class II relationship
while offset is meant for class I molar
relationship.
Mandibular Arch
Canines
Canine tip is taken from minimum translation
series brackets for mesial translation while
torque is taken from Andrew standard SWA.
Counter rotation feature for canine is taken
from minimum translation series for mesial
translation.
Premolars
Premolars tip correlate with Andrew medium
translation series brackets. Torque values
remain similar to standard SWA while counter
rotation feature values are from medium
translation series for mesial translation.
Molars
Molars have tip of medium translation series
for mesial translation. 1st mandibular molar
torque remain same as that of standard SWA
while 2nd molar torque was made equal to 1st
molar. Counter rotation feature were also taken
from medium translation series brackets for
125
Selection of Bracket Prescription
mesial translation.
Controversy
In mandibular arch canine is given minimum
translation series counter rotation feature and
tip values while molars and premolars have
medium translation series values. Second
molar torque was made equal to 1st molar.
Giving less torque on second molar increase
their chances of coming in cross bite as it's a
common finding that 2nd molars are usually
present slightly buccally as compared to 1st
molar in finished cases using Roth prescription.
Roth Justification for his prescription
Roth3 while giving his prescription gave some
justification for the specific selection.
Maxillary Arch
Roth3 justified his prescription by explaining
that 5° extra torque was added to maxillary
incisors keeping is line with his treatment
philosophy of overcorrection and
accommodating torque loss by wire play. So
without moving to full dimension wires the
clinician can attain natural inclination of
incisors.
For canines, Roth used -2° torque which was -
5° less than Andrew prescription. This was
done to avoid reactionary effect of building
more positive torque into the incisors brackets.
This is explained in the figure 6.46. The final
torque of canine would be -7° due to
reactionary forces from the wire and because of
wire play. If no wire play is present the final
torque of the canine would be -2°.
Also canine tip was increased by +2° to
accommodate tip loss in extraction cases as
distal translation of canine take place and it is
also helpful to get better canine guidance.
Canines was also given 2° rotation to mesial
so that when it is translated distal, mesial
builtin rotation compensate the effect of distal
 CHAPTER 6
Selection of Bracket Prescription

B C

Figure 6.46 A .A rectangular wire passed through maxillary incisors and canine brackets. The slots opening of the maxillary
incisors is facing downward causing the wire to rotate clockwise on exiting the lateral incisor bracket. This clockwise rotated wire
when passes through canine bracket whose slot opening is facing upward will cause the canine bracket to rotate clockwise while
canine bracket slot will cause the wire and so the incisor brackets to rotate counterclockwise. So positive torque would be
expressed on incisors and negative torque would be expressed on canine. If the incisors have more positive torque, than reactionary
forces of wire leaving from incisors will cause more negative torque on canine. This only happen when wire play is present. If no
wire play is present all the torque built within the bracket would be expressed. B. Wire exiting lateral incisor in a clockwise fashion.
C. Wire engaging canine bracket clockwise at an angle thus negative torque expression in canine.

rotation that occur during distal translation of canine.

Premolar torque was kept the same while the tip

was decreased. Though there was no
justification given for using minimum
translation angulation in both premolars nor
does there is any logical basis of decreasing tip
after giving 2° mesial offset for counter A
rotation. This decreased tip can accommodate
increased tip on canine but the roots of these
teeth come close to each other at end of
treatment. Also 2° mesial rotation was added to
premolar brackets. The justification was that
this was done to counter the of effect distal
traction of these teeth. As Roth favored
headgears in his mechanotherapy this addition B
seems logical.
Figure 6.47 According to Roth -14° torque should be
On 1st and 2nd molars buccal root torque was given to maxillary molar to counter the effect of palatal cusp
hanging during translation. A. Palatal cusp hanging in
increased from -9° to -14°.The increased torque maxillary molar after translation. B. No cusp hanging.
126

Placement of orthodontic brackets
In this Chapter
Mesiodistal position of brackets
Checking mesiodistal position of the
brackets
Modifications in mesiodistal position of
the bracket
Axial or long axis position of the brackets
Importance of axial position of brackets
Checking axial position of brackets
Modifications in axial position of
brackets
Vertical position of brackets
Modifications in Vertical position of the
brackets
Prescriptions in preadjusted edgewise brackets
are built after taking prescription values from a
certain point or area on labial surface of the
tooth. The prescription built into the bracket
will work best if the brackets are placed at that
specific area. Mostly that specific area where
the brackets needed to be placed is also
pinpointed by the inventor of the prescription.
During orthodontic bonding of preadjusted
brackets the orthodontist must place brackets
accurately in vertical, mesiodistal and axial
planes as advocated for that prescription
or based on his clinical experience. These
153
CHAPTER
7
Importance of vertical position of
brackets
Bracket positioning gauges
Parts of gauges
Position of the gauge during bracket
placement
Bracket placement by wire guidance
Position of clinician during brackets
placement
accurately placed brackets will give better
control on three dimension position of the
teeth during treatment. An accurately placed
bracket will also result in better expression of
its builtin prescription and orthodontist will
need less wire bending and complex
mechanics during the course of treatment.
Mesiodistal position of brackets
It is a general saying in orthodontics that
brackets should be placed at mesiodistal center
of the teeth. This statement is partially correct as
this rule can't be applied to all the teeth. A more
Placement of orthodontic brackets
clear description for right mesiodistal position
of brackets was given by Andrew1 that brackets
should ideally be placed at the mid
developmental ridge of the teeth. The correct
mesiodistal position of brackets on different
teeth is given as under.
Maxillary and mandibular incisors
Bracket should ideally be placed at
mesiodistal center of maxillary and
mandibular incisors. The mid developmental
ridge of these teeth is also present at their
mesiodistal center of the labial surface (Figure
7.1).
Figure 7.1 Vertical lines showing mesiodistal center of
the upper and lower incisors. Brackets should be placed at
the recommended height on this line.
Maxillary and mandibular Canines
Placing brackets at the mesiodistal center of the
canines will result in contact point error and
slight rotation of the teeth as the mid
developmental ridge of upper and lower canines
lies slightly mesial to the mesiodistal center of
the teeth and is more mesial in case of lower
canines. So bracket is placed slightly off center
and toward mesial, in case of canines (Figure
7.2).
CHAPTER 7
Figure 7.2 The vertical lines on maxillary and mandibular
canines indicate the mid developmental ridge of the canines
and ideally the middle of the brackets should coincide with
this line.
Mandibular Premolars
Roth 2 purposed that premolars brackets should
be placed at area of maximum convexity which
is usually the mesiodistal center of the teeth and
mid developmental ridge also lies in this area.
Sometimes the area of maximum convexity lies
slightly mesial to the mesiodistal center but
degree of mesial deviation is less than that of
canines. The difference between bracket
placement on premolars and anterior teeth is
presence of a lingual cusp on premolars which
must be taken into consideration while placing
the brackets. In mandibular premolars the
buccal and lingual cusps lies at the same level in
the mesiodistal perspective. So when placing
lower premolars brackets the scribe line of the
bracket should coincide with line connecting
the buccal and lingual cusps (Figure 7.3).
154
 CHAPTER
Bonding in Orthodontics
8
In this Chapter

Tooth Cleaning
Enamel Roughening or acid Etching
Sealing the etched enamel surface
Bonding
Bonding in special circumstances
Indirect bonding

Historically orthodontic brackets were soldered

to bands and eventually banded to teeth. As
bands need space between the contact points at
time of their placement and leave spaces
between teeth at end of treatment so they were
not a preferred method.
With the introduction of acid etching by
Buonocore 1 in 1955 banding of teeth was
eventually abandoned with time and is now only
used on molars in cases requiring special
mechanics like headgears. Extensive details
about bonding are given in almost all the text
books of orthodontics so only a brief review on
this topic would be given here.
Bonding of brackets can be done either directly
or indirectly. Steps in direct bonding of bracket
are given.
2. Enamel roughening of labial or lingual
surface of tooth by acid etching
3. Sealing of etched surface
4. Bonding
1) Tooth Cleaning
This step is only done in patients in whom
there is plaque or thick pellicle layer over the
enamel surface at the time of bonding.
If only pellicle is present then pumicing of
teeth alone is sufficient but if plaque or
calculus is also present over the enamel
surface then scaling is done which is
followed by pumicing (Figure 8.1).

1. Tooth cleaning

189
Bonding in Orthodontics
Figure 8.1 Pumicing teeth with a polishing paste and
pumice powder.
Clinical Notes
Pumicing before etching is controversial 2-4
if conventional etching is done but clinician
should do pumicing if self-etching primer 5-7
is used.
2) Enamel Roughening or acid Etching
Enamel roughening or acid etching is done to
create retention areas for the adhesive on the
enamel surface.
Moisture control is important during this
step and rest of the steps that follows.
Good moisture control is provided by using
cheek/lip retractors and high volume
section. This arrangement of moisture
control is usually sufficient in majority of
the cases but in some cases where patients
have increased salivary flow, special
gadgets are available that combine lip/
cheek retractors, saliva ejectors and tongue
guards (Figure 8.2). Cotton rolls are also
used to increase moisture control. Some
clinician also uses antisialogogue like
atropine sulphate to create a dry field for
brackets bonding. Antisialogogues can be
used on patients having excessive salivary
flow but evidence 8 doesn't support their
routine use during orthodontic bonding.
Before going for enamel conditioning
enamel surface should be dried with oil free
air. Enamel conditioning is conventionally
CHAPTER 8
A
B
Figure 8.2 A Nola dry field system combining all the
necessary gadgets for good moisture control during enamel
conditioning. This system is especially helpful in indirect
bonding.
done with 35 - 37% phosphoric acid. Enamel
roughening by sandblasting has also been
proposed but sandblasted enamel yield lower
bond strength 9-13than acid etched enamel.
Sandblasting first followed by conventional
etching have also been proposed but bond
strength of brackets with this combination
technique is controversial 14, 15 than doing
conventional acid etching alone. Lasers have
also been advocated for enamel etching 16-19
either alone or in combination 20 with acid
etching. But due to high cost of lasers and
more safer application of conventional
etching the use of laser for enamel roughing
is still a novel approach in orthodontics.
In enamel etching with 37% phosphoric acid
the acid is available in both liquid and gel
form. The liquid form of the acid has
190
 CHAPTER
Adhesive Remnants Removal
10
In this Chapter

Hand instrumentation for adhesive Discs

removal
Finishing and polishing auxiliaries
Adhesive removing pliers
Ultrasonic scalers
Ligature wire cutters
Sandblasting or air abrasion
Hand Scalers
Adhesive remnants removal by Lasers
Rotatory instruments
Burs
Carbide burs
Diamond burs
Steel burs
Brown and green stones
Composite burs

After orthodontic brackets removal, adhesive Removal of these adhesive remnants should be
remnants needed to be removed from the tooth done without causing any damage to enamel.
so that enamel can be returned to its
pretreatment condition. These residual adhesive
if remained attached to the teeth will be a
potential plaque retentive area and may get
discolored with time.

The amount of these adhesive remnants

depends upon the type of bond failure. If bond
failure during debonding occurs at bracket
adhesive interference, more adhesive needed to Figure 10.1 Adhesive remnants on the tooth after
be removed as compared to a bond failure at debonding. Bond failure occur at the bracket adhesive
enamel adhesive interference (Figure 10.1). interference. Such bond failure require more time to clean
adhesive from the tooth enamel.
239
 CHAPTER
Recycling of orthodontic brackets
11
In this Chapter

Introduction Chemical Method

Recycling of orthodontic brackets Sandblasting
Ultrasonic Cleaning Laser Recycling
Electropolishing
Adhesion Enhancement
Silane coupling Agents
Adhesion Boosters
Rotatory instruments
Flame Method
Buchman modiifed flame method
Modified Buchman method ,The Acid
Bath
Limitations of flame method
Lew and Djeng Method

Introduction these circumstances are as follow.

Recycling or reconditioning are different terms 1. Bracket debonded by patients

used for reusing orthodontic brackets which
This usually occurs while masticating hard
were once bonded in clinical practice and were
food, aggressive tooth brushing or by traumatic
latter debonded accidently by the patient or
forces especially in children while playing
intentionally by the clinician. 5% to 7% of
sports. Some externally motivated patients also
brackets bonded with light cured or chemical-
intentionally debond the brackets to show their
cured composite resins debond1, 2 in clinical
unwillingness towards treatment.
practice under different circumstances. Some of
255
 INDEX
A Bracket prominence,63,86,87,113,
Abfraction, 229
Access bevel, 82
Accessary slots, 61,65,77,79
Accessory tube, 82
Acetone, 222,264
Active ligatures, 134,235
Active self ligating brackets,72,73,264
Adhesion boosters, 255,260,261,273
Adhesion enhancement, 255,257,260
Adhesive precoated brackets,193,196
Adhesive remnants,210,261,265,268
Adhesive removing plier 203,214,240
AISI 21,24,25
All Bond 2, 261
All Bond 3, 261
Alumina Brackets,36
Amelogenesis imperfect,229
Andrew plane,165
Antirotation,98,116
Antisialagogues,190
Aperture diameter,45,46
ASTM,27
Attrition,33,34,160,161,178,229
Austenitic stainless steel,24,25,32,263
Auxiliary features,77,123,
Auxiliary procedures,257
Auxiliary spring ,6,65,67,
Axial position,114,160,161,184,194
B Composite resin ,56,194,223,227,241
Band removing plier ,214,241
Bandeau appliance,1,2,3
Base method, 19,203,205,207.209,257
Begg appliance,5,6,61,172
Big Jane machine,272
Bis GMA ,227,228,235,260
Black triangle,94,161,162,164
Bleaching ,195
Bonding base shape ,57
Bracket base surface area,56,57,59,266
Bracket identification
Bracket identification marks ,58,80
Bracket removing plier ,210,215,249
Bracket sitting area,171
Bracket stem,18,100,208,212,259,
Brazing,13-21,38,42,209,260,
Bristle brush,240,249
Broussard bracket,8
Brown and green stones,243,246
Brown part,16
Buccal groove,88,93,97,127,128,133
Bunsen flame,262
C Deligation saddle,82
Calcium phosphate ceramics,36-38
Canine tie backs ,134
Carbide burs,195,227,243-253
Casting,14,,15,18,23,27,43,47,51.260
Central fossa,84
Ceramic injection molding ,18,36
Ceramic reinforced plastic,216,217
Chamfered slot walls,70,72
Chemical Retention ,50-57,218,220
Chromium oxide,22,26,28,
Chromophores,231
CO2 laser 234,235,252,270
Cobalt Chromium Brackets,27,50,259
Cold working,20,23
Collapsible base ,219,220,222
Composite burs , 243,246,247
Composite plastic brackets ,32,216
Compound contoured base,57,59,104
Computer numerated milling ,16
Connectors,94,160,161,164
Contact angle ,30,46,66,69,102
Contact points,117,118,189,256
Contact sports,256
Continuous mode ,234
Convenience features ,79-82
Corrosion resistance,17,19,21,24-
28,111,260
Counter buccolingual tip,102
Counter rotation ,116,117, 120,122 ,124-
126,130,131,157
(I)
CP titanium,28-30
Cracked teeth ,209
Crown Angulation ,92-94
Crown inclination,99
Crown morphology,136,161
Crown remover,226
Curve of Spee,117, 118,121,123,129, 132,
165,166, 173
D
Debonding plier,205,206,208,210-230
Debracketing, 203
Dentinogenesis imperfect,194,209, 226, 256
Differential anchorage ,6,10
Direct bonding ,169,171,189,256
Distal offset ,88-90,134,137
Distal translation ,95,96,117,124-126
Double mesh base,42,44,269
Dougherty gauges,181
Duplex stainless steel,26
Dust confinement chamber,266
Duplex stainless steel,26
Dust confinement chamber,266
E
E arch,3,4
Edge bevel,107,108
Edgewise appliance,7,13,64,104
Elastic ligatures,72,82
Elastic modules tie backs,132,134
Electrolytic solution ,259
Electromagnetic spectrum,230,231, 233, 234
Electropolishing
Electrothermal debonder , 229
Embrasure,91,92,94,155,160,161,164
Embrasure line,85-90
Enhance polisher,249
Er,Cr:YSGG lasers ,270
Er:YAGlasers,195,233,252,270,271
Erosion ,229
Esmadent,259,271,272
Ethanol ,53,222
Excimer lasers ,232,233
 INDEX
F L
FA point,58,121,165,171,
FACC,92,93,97,99,105,165
Facial point ,85-87
Facial prominence ,85,86,88,90
FDA,257
Feedstock,16
Ferritic stainless steel,25
Fiber reinforced ,246,247
Filling adhesive ,194
First order bend,61,62,163
Flame gun ,229,262,264
Flame method ,19,48,50,70,257,258, 262-
265,270,273
Flamepyrolytic method,260
Flash ,22,168,193,196,218,222-227,
242,266
Foil mesh base ,42,43,47
Free play,107
Frequency,224,231,251,271
Friction resistance,16-18,27,29,31,32,
37,70-73
Gated pulse mode ,234
Gauze or woven mesh base,42,43,46, 50
Gingival hyperplasia,77,209
Gold plated carbide bur,261
Green part ,16
Hand scaler,240,243
Hard tissue lasers,231
Headgear tube,82
HEMA,227,228
Horizontal slot,5,10,65,80
Howe plier,208,212
Hybrid copolymer,32
Hydrofluoric acid,195
Implants,28,34,161,162
Impulse debonding,205,226,227
In and out bends,8,9
Indirect bonding,169,190,195,198,256
Integral bases,47
Interarch relationship,84
Isopropyl alcohol,264
Kinetic energy,227
Kobayashi hook,78
KrF Lasers,270
Microetched bases,42
Microleakage,192
Microretention,47,48,195,240
Mid-developmental ridge,92,93,154,156,158,165
LA point,121,165
LACC,92,93,99,105,159,165 Milling,14-18,20,21,37,47,194
Laminated mesh base,42 Mini mesh base,42
Minimum Translation series,95,96,102,123-125
Lang brackets,8
Laser structured bases,48,50,54,267,268 Moisture insensitive primer,192
LED curing light,192,195,199 Molar offset,88,90-93,98,127
Lewis brackets,7,8 Moment arm,66,69
Lift off debonding plier,199,212,213 Monobond plus,261
Ligature cutter,82,210,211,221,242 Monocrystalline brackets,35,37,38,55,
Light wire appliance,6,9,10,172 232,233,235,265
Line pressure,47,197,260,263,266-269
Lingual brackets,10,111,214,215
Long axis position,93,158,160,161,184 N
Luting adhesive,50,53,194 Nd:YAG,35,48,233,252
Nickel allergy,19,20,22,28,30,31,33
M Non vital teeth,220,221
Notching,205,223
Magnetostrictive scaler,224,240
Manufacturer tolerance,99,108
Marginal ridges,166-173
Martensitic stainless steel,25,26
O
Occlusal plane,92,93,97-
Maximum translation series,95,96,102,123,124
99,105,106,112,117,127,129,133,135,
Meccaca Monkey,228
136,162,166,182
Mechanical Retention,42,46-48,50-
Open area percentage,46,47
52,54,55,218
Optimesh base,42
Mechanotherapy,107,109,126,130
Ormesh base,42
Medium translation,95,96,102,119,124,125,137
Ortho bonding,271,272
Mesh diameter,44,45
Ortho Solo,261
Mesh gauge,44
Orthotronics,271,272
Mesh number,44-46,50,267
Mesh type bases,48,50
Mesial offset,90,122,126
Mesial translation,95,96,124,125 P
Mesiobuccal cusp,84,88,91,92,97,98,123,127,156 Passive self ligating
Mesiobuccal groove,88,91,92 brackets,10,72,73,109,264
Mesiodens,161,162 Pellicle,189
Mesiodistal Crown tip,92 Peppermint oil,222
Mesiodistal position,153,154,156,157,183-186,194 Perforated bases,42,43
Mesiolingual cusp,84,91,92,127 Phosphoric acid,190,195,240
Metal injection molding,14-18,27,47 Photoablation,232,235
Metal sintered bases,48 Photoetched bases,42,47
Metallic luster,263 Photon,231
Micro mesh base,42 Piezoelectric scaler,224,240
(II)
Pin and tube appliance,4
Plasma arc curing light,192
INDEX Separators ,199
Shape of brackets,80
Torque in the Base,58,100
Torque in the face,58,59
Plasma coated brackets,48,50 Siamese bracket,7 Torque play,15,72,107,108,110
Plastic Brackets,14,19,31-34,51-53,68-71 Side cutter,210,213,223 Torque zone,112
Plastic injection molding,19,31 Silane coupling agent,50- Torqueing springs ,63,79
Plastic primer,51 54,195,260,261,264,269 Tribochemical method ,260,261
PoGo polisher,247,250,253 Silica coating,52,261,264,269, True twin brackets ,68,69
Polyacrylic acid,191,222 Silica lined slot,70 Tungsten carbide bur,244-253,261
Polycrystalline brackets,18,34-38,55,232-235 Silicon tray,196,197 Twin bracket,7,35,56,68,69,208
Polymer mesh base,51,54 Single mesh base,42,44,269 Twin wire appliance,6,7
Polyoxymethylene Brackets,31,32 Single slot brackets,7,67
Sintering,16-18,26,35,36
Polyurethane brackets,31,32
Porcelain veneers,195
Power arms,77-79,81,94,95,99
Slip planes,218
Slot base,71,72,86,87,105,
U
Preadjusted edgewise 110,116,117,208 Ultra pulse mode ,234
Slot creep,32 Ultrasonic cleaning ,257,258,262,264-266,273
appliance,8,9,64,83,102,153,158
Precious metal brackets,21,30,31,51 Slot point,58,77,86,87,94,95,116 Ultrasonic debonding ,22,224-227

Precipitation hardening,25,26 Slot rotation,116 Ultraviolet light ,233

Prescription,9,10,15,22-24,61-63,67, 69, So flex discs,247,248,253 Universal brackets ,6,7

83,87,90-96 Sodium bicarbonate,259,272

Primer 31,32,51.190,191,199,260, 261, 270
Protective goggles ,194,195,222
Soft tissue lasers,231,233,234
Soldered,2,4,7,13,162,189,256
Speed brackets,166
V
Pulse mode ,231,234 Van der Waal forces ,227
Pumicing,189,190,199240,243,249-253 Standard brackets,61,69,95,100,
Vertical groove ,93
102,119,120,129
Vertical Mid Scribe line,79

R Steel burs,139,243
Recycling ,110,198,206,208,209,215,227,251,255
Replaceable tips,221
Resin modified Glass ionomer cement,56,194
Ribbon arch appliance,4-6,61
Roller coaster effects,34,121
Rotatory instruments,240,243,252,255,257,261
Roth extra torque,131
Roth Surgical,129,130
Steel ligatures,34,72,109
Straight wire appliance,8,9,58,84,94,
100,102,117,119,162
Super Austenitic Stainless steel,25
Super Ferritic stainless steel,25
Super pulse mode,234
Super snap discs,247,248
Super torque,123,127,128,131,136,141
Supermesh base,44,50
Vertical slot ,5,7,8,61,65,67,79,80,219
Vickers hardness,17,23,109
W
Wagon wheel effects,114,115,119,132,
134-136
Wavelength ,192,230-235,270
Weingart plier,212,219,220
Wick stick,167,181

S T Wing method,19,205-210,212,214-217,
219,257,260
Wire bevel,108
Thermal ablation ,232,235 Wire diameter ,44-46,267
SAE,21
Thermal softening ,232,234,235 Wire guidance,110,143,163,183,184
Sandblaster,251,252,266,267
Third order bends,63
Scaling,189,224,245,250,
Tip edge,10,65,67,79
Second order bends,62
Self etching primer ,190
Self ligating brackets ,9,10,72,109,
Tip edge plus brackets,10,65,67
Tipping,4,10,64,65,123,129 Z
Tipping springs,65
214,264,265 Zirconia Brackets,36,38
Titanium brackets,21,27-31,50,111
Separating medium ,196,197
(III)