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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
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

CHAPTER

1

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

Begg Appliance Other Appliances Modification of Standard Edgewise Appliance Self ligating brackets Light wire Appliances Lingual brackets Customized labial brackets

1
1

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 record 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

1

  • 2 .These ranges from crude metal wire loupes to metal bands wrapped around individual teeth in ancient Egyptian mummies . Pliny the Elder

3

(23-79 AD) was the first to mechanically align elongated teeth .

4

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.

1 CHAPTER another French dentist used swelling threads and wooden wedges to separate crowded teeth. Horace
1
CHAPTER
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
Figure 1.1
Pierre Fauchard
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.
5
Figure 1.2
Bandeau Appliance
Modifications of bandeau appliance
Edward Hartley Angle (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 science 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
6
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)
2
Historical perspective of Orthodontic Brackets

CHAPTER

2

Material Perspective of Orthodontic Brackets

In this Chapter

   

Introduction Manufacturing Techniques

Casting Milling Sintering Metal injection molding (MIM) Ceramic injection molding (CIM) Plastic injection molding (PIM) Brazing Cold working

Metal Brackets

Stainless steel brackets Cobalt chromium brackets Titanium brackets Precious metal brackets

Plastic Brackets

Plastic Polyoxymethylene brackets Polyurethane brackets Composite plastic brackets

Ceramics Brackets

Aluminum oxide or Alumina (Al O ) brackets

2

3

Monocrystalline brackets Polycrystalline brackets

Zirconia brackets Calcium phosphate ceramic brackets

13
13

Introduction

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 was the first to use

1

stainless steel in edgewise appliances. Ernest 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 :

less chance of corrosion of cobalt chromium brackets. by TP orthodontics with 0.5 % nickel. Nu-

less chance of corrosion of cobalt chromium brackets.

by TP orthodontics with 0.5 % nickel.

Nu- Edge® Mini Cobalt Chromium Brackets

Figure 2.19

less chance of corrosion of cobalt chromium brackets. by TP orthodontics with 0.5 % nickel. Nu-
27
27

Cobalt chromium brackets were introduced in mid 1990s as a low nickel alternative to stainless steel. Cobalt chromium brackets are fabricated from casting or metal injection molding.

Type and Composition of Cobalt based alloys

Cobalt based alloys can be divided into three categories .These are:

  • 1. Cobalt based wear resistant alloys

  • 2. Cobalt based high temperature alloys

  • 3. Cobalt based corrosion resistant alloys

In these alloys cobalt based wear resistant alloys are used presently for orthodontic 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 and 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.

29

29

Selection of Stainless steel brackets

Stainless steel brackets with good corrosion resistance should be selected. Good corrosion resistance of a bracket is more important than its nickel contents. Ideally SS brackets should not be used for nickel sensitive patients. Conventional SS brackets with softer base component and harder slot/wings component should be preffered.17-4 PH MIM brackets are a good choice for proper torque expression. New bracket should always be the first choice by orthodontists to avoid corrosion.

Corrosion Resistance

32

Because of increase chromium contents there is

Table 2.3 Cobalt-Base Wear-Resistant Alloys

Cr

25-30%

Mo

7% max

W

2-15%

C

0.25-3.3%

Fe

3% max

Ni

0.5%max

Si

2%

Mn

1%

Co

Balanced

Where Cr=Chromium, Mo=Molybdenum, W = Tungsten, C =Carbon, Fe = Iron, Ni=Nickel, Si = Silicon

titanium brackets with both stainless steel and beta titanium wires.

30

30, 31

In terms of friction resistance cobalt chromium brackets show comparable but slightly less amount of friction than that of stainless steel brackets when used with stainless steel wires. But CoCr brackets offer more friction than

Friction Resistance

Brackets

Cobalt

of

Chromium

Properties

less chance of corrosion of cobalt chromium brackets. by TP orthodontics with 0.5 % nickel. Nu-

Material perspective of Orthodontic Brackets

2 CHAPTER Selection Cobalt chromium alloys have good corrosion resistance and have a highly polished surface.
2
CHAPTER
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.
4 CP titanium, which offers highest strength and
moderate formability. Composition of different
grades of CP titanium is given in table 2.5.
21,
37
Titanium Brackets
Titanium metal has excellent biocompatibility
and increased corrosion resistance so it has
wide ranging surgical application from artificial
heart valves and hip joints to dental implants.
18, 33, 34
In orthodontics to overcome the release of
nickel from stainless steel brackets which may
cause nickel allergy in some patients, titanium
brackets have been introduced as nickel free
alternatives to stainless steel in mid 1990s.
Contemporary titanium brackets 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.
35, 36
37
Types of Titanium
From material science perspective titanium has
the following three types:
Due to release of vanadium from 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
1.
αTitanium
Corrosion Resistance
2.
β titanium
Titanium and titanium alloy brackets have
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.
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 stable 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.
23
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
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
2 CHAPTER than conventional ceramic brackets and these brackets don't cause enamel damage. Vivo: Aging and
2
CHAPTER
than conventional ceramic brackets and these
brackets don't cause enamel damage.
Vivo: Aging and Related Phenomena. New York, NY: Quintessence;
2003:141–156.
Selection of ceramic brackets
8. Brockhurst PJ, Pham HL. Orthodontic silver brazing alloys.
AustOrthod J. 1989;11:96–99.
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.
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.
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.
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
References
biocompatibility. Angle Orthod. 2002 Jun;72(3):222-37.
19.
Schiff N, Dalard F, Lissac M, Morgon L, Grosgogeat B. Corrosion
1.
Hotz RP. The changing pattern of European orthodontics. Br J Orthod
resistance of three orthodontic brackets: a comparative study of three
1973; 1:4-8.
fluoride mouthwashes. Eur J Orthod. 2005 Dec;27(6):541-9.
2.
Matasa C. Characterization of used orthodontic brackets. In: Eliades
20.
Oh KT, Choo SU, Kim KM, Kim KN. A stainless steel bracket for
G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials in Vivo:
orthodontic application. Eur J Orthod. 2005 Jun;27(3):237-44.
Aging and Related Phenomena. New York, NY: Quintessence;
21.
Eliades T, Zinelis S, Eliades G, Athanasiou T. Characterization of
2003:141–156.
as-received, retrieved and recycled stainless steel brackets. J Orofac
3.
Zinelis S, Annousaki O, Makou M, Eliades T. Metallurgical
Orthop. 2003;64:80–87.
characterization of orthodontic brackets produced by Metal Injection
22.
Hunt NP, Cunningham SJ, Golden CG, Sherif M. An investigation
Molding (MIM). Angle Orthod. 2005 Nov;75(6):1024-31.
into the effects of polishing on surface hardness and corrosion of
4.
Floria G, Franchi L. Metal injection molding in orthodontics.Virtual
orthodontic archwires. Angle Orthod. 1999;69: 433–440.
J Orthod. 1997:2.1.
23.
Brantley WA. Orthodontic wires. In: Brantley W, Eliades T, eds.
5.
Coley-Smith A, Rock WP. Distortion of metallic orthodontic brackets
Orthodontic Materials: Scientific and Clinical Aspects. Stuttgart,
after clinical use and debond by two methods. Br J Orthod. 1999
Germany: Thieme; 2001:95.
Jun;26(2):135-9.
24.
Eliades, T., Eliades, G., Brantley, W.A. (2001). Orthodontic
6.
Zinelis S, Annousaki O, Makou M, Eliades T. Elemental composition
brackets, in: Brantley, W. A., Eliades, T. (Eds.), Orthodontic Materials:
of brazing alloys in metallic orthodontic brackets.Angle Orthod.
scientific and clinical aspects Thieme, Stuttgart, 146-147.
2004;74:394–399.
25.
Platt JA, Guzman A, Zuccari A, Thornburg DW, Rhodes BF, Oshida
7.
Matassa C. Characterization of used orthodontic brackets. In:
Y, Moore BK. Corrosion behavior of 2205 duplex stainless steel. Am J
Eliades G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials In
Orthod Dentofacial Orthop. 1997 Jul;112(1):69-79.)
26.
Eliades T. Orthodontic materials research and applications: part 2.
38
Material perspective of Orthodontic Brackets

CHAPTER

3

Selection of Bracket Base

In this Chapter

   

Bracket Base Retention Design

Stainless steel Brackets Mechanical Retention

Perforated bases Mesh type bases Integral bases Photoetched bases Microetced bases Metal sintered bases Laser structured bases Plasma coated brackets

Chemical Retention

Stainless steel brackets and Cross infection

Titanium Brackets Cobalt Chromium Brackets

Precious metal Brackets Plastic Brackets

Chemical Retention Mechanical Retention

Combination of chemical and mechanical retention

Ceramic Brackets

Chemical Retention Mechanical Retention Micromechanical retention Ceramic brackets with prestressed base Combination of different retention designs

Bracket base surface area Bracket base shape Bracket identification marks Torque in the Base

41
41

The base component of orthodontic brackets 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.

Bracket Base Retention Design

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

       
   

CHAPTER 3

CHAPTER

 

Selection of Bracket Base

are not provided from the manufacturer some basic informations are available.

  • a) Foil mesh base

 
  • b) Gauze or woven mesh base

 

1) Stainless steel Brackets

  • c) Mini mesh base

 

Most orthodontic brackets used in contemporary orthodontics are made of

  • d) Micro mesh base

stainless steel which mostly uses mechanical

  • e) Optimesh base

retention because stainless steel doesn't form any chemical union with adhesives. Stainless

  • f) Ormesh base

steel bracket base is either integral part of the bracket or is made separately and then joined

  • g) Laminated mesh base

 

to the main body of the bracket by brazing or

  • h) Single mesh base

welding (Figure 3.1).Different types of stainless steel bracket bases are given in the

  • I) Double mesh base

following text.

  • j) Supermesh base

1. Perforated bases

Description

of

some

important

mesh

Brackets with perforated bases are one of

1

2 , 3 , 4 , 5 , 6

2. Mesh type bases

designs is as follows.

 

the oldest bracket designs for mechanical

a) Foil mesh base

retention (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

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 . Foil and woven mesh bases provide superior retention than perforated bases and many other

2,

3,

7,

8

4, 7, 9

2, 4, 10

11

 

designs . Because of these disadvantages perforated bracket bases

b r a c k e t b a s e d e si g n s u s e d i n

went into disuse.

contemporary orthodontics . Foil mesh bases can be simple or microetched, photoetched or plasma coated by the

Mesh type bases have replaced perforated bases and are most popular type used in contemporary orthodontics. Following

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

different terms are used for mesh based bases in literature and by manufacturer owing to slight variation in mesh design.

areas and so bond strength therefore spot welding have been taken over by silver based laser welding .

Foil mesh bases can be single mesh or double mesh.

42
42
CHAPTER 3 CHAPTER lower bond strength than high filled adhesives. Another alternative is to use glass
CHAPTER 3
CHAPTER
lower
bond
strength than high filled
adhesives.
Another alternative is to use glass ionomer or
resin modified glass ionomer 41 cements
(RMGIC) with ceramic brackets as glass
ionomer cements have shown to have
decreased 42,43 but clinically acceptable bond
strength 32, 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
bond strength.
Glass ionomer cement also has the added
advantage of fluoride release and so it
prevents enamel decalcification and
formation of white spot lesions during
orthodontic treatment.
Figure 3.27 Greater the retentive bracket base surface
area greater would be the bond strength.If the base surface
area is not retentive then no matter how much wider is the
bracket the bond strength will remain minimum or
bracket will fail to bond. The above brackets have
manufacturing faults which have increased the surface
area but area is not retentive. So instead of favoring bond
strength the area can act as plaque reservoir and may lead
to development of white spot lesion under the bracket
base.
Selection of ceramic bracket base
Ceramic bracket base using only chemical
retention is neither marketed nowadays nor
should be used due to risk associated with
enamel damage. All other commercially
available ceramic brackets are acceptable for
orthodontic purpose as long as suitable or
recommended debonded techniques are
used. My personal recommendation after
going through all the available literature and
personal experience is that ceramic brackets
with plastic base or prestressed base should
be used as it debond safer than other base
types.
of increasing or decreasing the bracket base
surface area. Proffit 48 purposed that width of
the bracket shouldn't be more than half of the
width of the tooth while MacColl 49
recommended that bracket base surface area
should be around 6.82 mm 2 . Usually the
manufacturer of brackets keep a larger base
area to give better bond strength and rotational
control .
Clinical implication of Bracket base
surface area
Increase Bracket base surface area
Advantages
This has the following advantages:
Bracket base surface area
An important technical specification that affects
the bond strength of orthodontic bracket is its
base surface area. Most orthodontists presently
use twin brackets. The surface area 26,47 of these
brackets range from 12.5mm 2 to 28.5 mm .
Greater the retentive bracket base area greater
would be the bond strength and vice versa
(Figure 3.27). But there is practical limitations
1. Increased bond strength. This is helpful
especially in case of plastic brackets which
offer less bond strength than other type of
brackets. Clinically acceptable bond
2
strength 50 is around 5.9 to 7.8 Mpa but bond
strength shouldn't exceed 51 than 13.5Mpa to
avoid enamel damage.
56
Selection of Bracket Base
 

CHAPTER

4

 

Selection of Bracket Slot

In this Chapter

   

Introduction

Bidemensional mechanics

Morphology of the brackets

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

Gingival offset brackets Slot modifications to reduce friction

Ligation: The fourth wall of Bracket slot Tie Wings of the brackets

Introduction

1

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

were incorporated in brackets to produce respective tooth movements . 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

61
61
CHAPTER 4 angulation of the teeth are also considered as 1st order bends. First order bends
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.
B
A
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
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.
Second Order Bends (Tip or Angulation
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
Figure 4.2 Maxillary lateral incisor brackets from two
different manufacturers having same builtin prescription.
The height or prominence of these brackets is different.
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 Bracket Slot

CHAPTER

5

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

77
77

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. Andrew 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

1

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

CHAPTER

6

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

Different Bracket prescriptions Roth Prescription Limitations of Roth Prescription MBT Prescription Alteration of prescription

83
83

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 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

1,2

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.

6 CHAPTER A detailed description on evolution of different types of orthodontic prescriptions is given in
6
CHAPTER
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.
with each key so that the readers can have a clear
knowledge
of
effects
and
limitations
of
a
prescription.
Key I: Interarch Relationship
1
2
Andrew Prescription
Key I as originally proposed by Andrew was
molar relationship. But in 1989 Andrew
changed the key from molar relationship to
1
Lawrence F. Andrew 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.
interarch relationship. Interarch relationship is
broader and more definite description of
occlusal relationship than relying on molar
relations only. Interarch relationship as key is
considered in this text because it will clear the
reader's mind about the basis and need of
prescription.
1
2
Key I have seven parts which are given below:
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.
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 2 molar.
nd
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.
Previously 1 this relation was. "The distal
surface of the distobuccal cusp of maxillary 1 st
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
2
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
nd molar contact and occlude , the better
would be the opportunity for normal
occlusion.
Part 3
st
The mesiolingual cusp
of
the
maxillary 1
permanent molar occludes in the central fossa of
mandibular 1st permanent molar.
84
Selection of Bracket Prescription
Part 4 Incorporating key I into bracket prescription The buccal cusp of the maxillary premolars have
Part 4
Incorporating
key
I
into bracket
prescription
The buccal cusp of the maxillary premolars
have cusp embrasure relationship with
mandibular premolars. The maxillary 2
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.
nd
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 1 , 2 and 3 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.
st
nd
rd
Selection of Bracket Prescription
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.
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.
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.
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
A
B
Figure 6.1
An ideal occlusion case meeting all the criteria of key I . A .Buccal aspects . B. Lingual aspects
85
teeth have the prominence value found in table Lateral Canine 1 st premolar 2 Maxillary Arch
teeth have the prominence value found in table
Lateral
Canine
1
st premolar
2
Maxillary Arch
2.1mm
2.9mm
2.5mm
CHAPTER
6
have same level of prominence while all the
incisors
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
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
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
less prominent than central incisors
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
nd premolar
1 st Molar
1.2mm
2.5mm
86
2 nd Molar
Selection of Bracket Prescription
found to be
2.35mm
2.5mm
2.4mm
2.4mm
Mandibular arch
1.2mm
2.9mm
1.9mm
1.65mm
2.35mm
B
A
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.
incisors
How it works?
6.1.
Teeth
Central
6 CHAPTER A A B Figure 6.43. A. Improper tip of central incisors and lack of
6
CHAPTER
A
A
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
A
BB
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.
bonding the second molars also help in leveling
of curve of spee .Usually leveling 1mm of curve
Clinical implication of Key VI
37
of spee
require less than 1mm of space. A
description of
curve of
spee is
given in the
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
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
Selection of Bracket Prescription
 
 

S – Standard Brackets

Selection of Bracket Prescription

T1 – Minimum Translation Brackets

by bracket prescription or by wire bending he is wasting his time but if the manufacturer is

T2 – Medium Translation Brackets

customizing brackets it's an innovation and you have to pay for that innovation.

T3 – Maximum Translation Brackets

For the orthodontist keeping a large inventory at

Tip and Torque

T4 – Maxillary Molar tubes or bands for Class II&III

orthodontic office means there is need for more financial resources and more office space. This is obviously against the core rules of good office

Andrew gave such a big inventory to make the

financial management. So unfortunately the very benefit of Andrew prescription to provide

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

individualized treatment to some extent became the most limiting factor of its wide acceptance.

work force and so more finances needed for the manufacturer. Also when there are so many different types of brackets, more time and

Both tip and torque values placed in Andrew prescription are slight different from Andrew original findings of normal occlusion .

2

 

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

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

Table 6.12
Table 6.12
119
119

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?

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

     

6

 
   

CHAPTER

Selection of Bracket Prescription

Table 6.13
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.

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

 

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.

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.

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 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

So Andrew prescription presents a dilemma for clinician in extraction cases. Moving to heavier

1) Anchorage loss

 
120
120
 
 

32

 
 

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

of variation 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

Selection of Bracket Prescription

Many clinicians also didn't agree with

3) Roller coaster effects

Andrew philosophy of leveling curve of spee with compensatory curves in wires in maxillary arch and reverse curves in wire in mandibular arch.

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

placement. Effects of change in height on

Because of these limitations different types of

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).

In early years of SWA class II elastics were used for sliding mechanics. In order to

experience. Some clinicians 3, 38 didn't agree with validity of placing bracket at the FA point to get an ideal occlusion while others 39, 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

bracket prescription have been discussed before.

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

Figure 6.45

Roller coaster effects and anterior deep bite

With time so many clinicians put forward their

and lateral open bite.

own prescriptions of brackets .For effective use

4) Root parallelism

of these prescriptions many of them also

121
121

Andrew measured tip values by using long axis or facial axis of clinical crown and not the whole tooth. There is always some degree

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

V. Super torque brackets for rapid correction of torque in class II div2 cases. Dr. Andrew

V. Super torque brackets for rapid correction of torque in class II div2 cases.

Dr. Andrew in one of his articles 42 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 1 st premolar extraction cases where both maxillary and mandibular canines are given maximum translation series brackets and both arches 2 nd 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 1 st and mandibular 2 nd premolars because of class II molar relationship. In this series maxillary canines and lower posterior

How Roth Made this Prescription?

addition of hooks for ease of mechanics.

brackets

such

double

and

triple

as

tubes,

VII. Different translation philosophy. According to Roth tipping of the teeth to some extent is accepted on round wires.

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.

123
123

accommodate torque loss by wire play.

brackets

IV.

anterior

to

More

torque

in

III. Leveling of curve of spee to some extent by placing anterior brackets more incisal.

diminution of force.

VIII. Many auxiliary features were added to

Table 6.15

 

Mandibular arch values of different prescriptions

 

Mandibular

Central

Lateral

Canine

1 st

2 nd

1 st Molar

 

2 nd Molar

 

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

0 -7ex n-

ex

-14 -7 ex n-

0

–22°

–5

12

–27

0

16

IV.

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

Edgewise

Tweed

0

0

0

0

0

0

0

0

0

0

0

0

0/6

0

0

0/6

                                 
V. Super torque brackets for rapid correction of torque in class II div2 cases. Dr. Andrew

Selection of Bracket Prescription

° 124 ue° Rotation° -14 14DR/0° Class II Tip ° Torque ° Tip 4DR Torque °
°
124
ue°
Rotation°
-14
14DR/0°
Class II
Tip
°
Torque
°
Tip
4DR
Torque
°
Tip°
Torque
°
Tip
°
Rotatio
Canines
Maxillary Arch.
Selection of Bracket Prescription
molars were taken from medium translation
series for mesial translation.
Both 1 and 2 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
feature was taken from minimum translation
series brackets for distal translation.
Both 1 and 2 premolar tip was taken from
minimum translation series brackets requiring
mesial translation. Premolar torque was taken
from Andrew standard SWA. Counter rotation
also taken from Andrew distal translation group
in minimum translation series brackets.
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
1 st &2 nd Molar
1 st & 2 nd Premolar
6
CHAPTER
Where MR=Mesial Rotation to counter distal translation. DR= Distal rotation to counter mesial
translation. P1 = 1 st Premolar P2 =2 nd Premolar , Class II= Molar Class II in cases where
only upper 1 st or 2 nd premolars are extracted .Reference for above Table 3, 40 .
An evaluation of origin of this prescription is
given.
Rotation
°
Tip
°
4DR
-1
2 MR
0
Torq
-30
2MR
Roth prescription is given in table 6.16.
are given maximum translation series brackets
and lower canine and upper posterior are given
minimum translation series brackets.
P2
Maxillary
Arch
+12
+5
+8
+9
-2
-1
-1
-7
0
Mandibul
ar arch
+13
Premolars
st
nd
Molars
nd
Torque
3
43
These comments by Andrew about Roth
prescription were made in 1976 and in the same
year Roth 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 Roth
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.
Table 6.16.
°
Teeth
Central
incisors
Lateral
incisors
Canine
st
Roth Prescription
+2
-1
+2
-11
+7
2 DR
-17
P1&
-22
Controversy mesial translation. In maxillary arch both canine and premolars brackets have minimum translation features builtin.
Controversy
mesial translation.
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 2 premolar extraction
cases where molar need mesial translation and
1st premolar need distal traction.
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 1 molar.
Giving less torque on second molar increase
their chances of coming in cross bite as it's a
common finding that 2 molars are usually
present slightly buccally as compared to 1
molar in finished cases using Roth prescription.
st
Selection of Bracket Prescription
nd
st
nd
Roth Justification for his prescription
3
The molar tip is meant for class II relationship
Roth while giving his prescription gave some
justification for the specific selection.
while offset is
relationship.
meant
for
class I molar
Maxillary Arch
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.
Roth3 justified his prescription by explaining
that 5° extra torque was added to maxillary
incisors keeping is line with his treatment
p h il o s o p h y o f o v e r c o rr e c ti o n a n d
accommodating torque loss by wire play. So
without moving to full dimension wires the
clinician can attain natural inclination of
incisors.
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.
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°.
Molars
Molars have tip of medium translation series
for mesial translation. 1 mandibular molar
torque remain same as that of standard SWA
while 2 molar torque was made equal to 1
molar. Counter rotation feature were also taken
from medium translation series brackets for
st
nd
st
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
125
6 CHAPTER AA BB C Figure 6.46 A .A rectangular wire passed through maxillary incisors and
6
CHAPTER
AA
BB
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
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
seems logical.
AA
BB
st
nd
On 1
and 2
molars buccal root torque was
increased from -9° to -14°.The increased torque
Figure 6.47 According to Roth -14° torque should be
given to maxillary molar to counter the effect of palatal cusp
hanging during translation. A. Palatal cusp hanging in
maxillary molar after translation. B. No cusp hanging.
126
Selection of Bracket Prescription

CHAPTER

7

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

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

153
153

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

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

CHAPTER 7 CHAPTER clear description for right mesiodistal position of brackets was given by Andrew that
CHAPTER 7
CHAPTER
clear description for right mesiodistal position
of brackets was given by Andrew 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.
1
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 7.2 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
2
Roth
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.
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).
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
Placement of orthodontic brackets

CHAPTER

8

Bonding in Orthodontics

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 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.

1

Bonding of brackets can be done either directly or indirectly. Steps in direct bonding of bracket are given.

189
189

1. Tooth cleaning

  • 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).

8 CHAPTER A Figure 8.1 Pumicing teeth with a polishing paste and pumice powder. Clinical Notes
8
CHAPTER
A
Figure 8.1
Pumicing teeth with a polishing paste and
pumice powder.
Clinical Notes
2-4
Pumicing before etching is controversial
if conventional etching is done but clinician
should do pumicing if self-etching primer
is used.
5-7
2) Enamel Roughening or acid Etching
Enamel roughening or acid etching is done to
create retention areas for the adhesive on the
enamel surface.
B
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
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 than acid etched enamel.
Sandblasting first followed by conventional
etching have also been proposed but bond
strength of brackets with this combination
technique is controversial than doing
conventional acid etching alone. Lasers have
also been advocated for enamel etching
either alone or in combination 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.
9-13
14,
15
16-19
20
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
Bonding in Orthodontics

CHAPTER

10

Adhesive Remnants Removal

In this Chapter

   

Hand instrumentation for adhesive removal

Adhesive removing pliers Ligature wire cutters Hand Scalers Rotatory instruments Burs

Carbide burs Diamond burs Steel burs Brown and green stones Composite burs

Discs Finishing and polishing auxiliaries Ultrasonic scalers Sandblasting or air abrasion Adhesive remnants removal by Lasers

239
239

After orthodontic brackets removal, adhesive remnants needed to be removed from the tooth 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 be removed as compared to a bond failure at enamel adhesive interference (Figure 10.1).

Removal of these adhesive remnants should be done without causing any damage to enamel.

CHAPTER 10 Adhesive Remnants Removal In this Chapter Hand instrumentation for adhesive removal Adhesive removing pliers

Figure 10.1 Adhesive remnants on the tooth after debonding. Bond failure occur at the bracket adhesive interference. Such bond failure require more time to clean adhesive from the tooth enamel.

CHAPTER

11

Recycling of orthodontic brackets

In this Chapter

   

Introduction Recycling of orthodontic brackets Ultrasonic Cleaning Electropolishing Adhesion Enhancement Silane coupling Agents Adhesion Boosters Rotatory instruments Flame Method Buchman modiifed flame method

Chemical Method Sandblasting Laser Recycling

Modified Buchman method ,The Acid Bath

Limitations of flame method Lew and Djeng Method

255
255

Introduction

Recycling or reconditioning are different terms used for reusing orthodontic brackets which were once bonded in clinical practice and were latter debonded accidently by the patient or intentionally by the clinician. 5% to 7% of brackets bonded with light cured or chemical- cured composite resins debond in clinical practice under different circumstances. Some of

1,

2

these circumstances are as follow.

1. Bracket debonded by patients

This usually occurs while masticating hard food, aggressive tooth brushing or by traumatic forces especially in children while playing sports. Some externally motivated patients also intentionally debond the brackets to show their unwillingness towards treatment.

INDEX

A

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

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 prominence,63,86,87,113, 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

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 Composite resin ,56,194,223,227,241 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 Deligation saddle,82

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

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

L

LA point,121,165

LACC,92,93,99,105,159,165

Laminated mesh base,42 Lang brackets,8 Laser structured bases,48,50,54,267,268 LED curing light,192,195,199 Lewis brackets,7,8 Lift off debonding plier,199,212,213 Ligature cutter,82,210,211,221,242 Light wire appliance,6,9,10,172 Line pressure,47,197,260,263,266-269 Lingual brackets,10,111,214,215 Long axis position,93,158,160,161,184 Luting adhesive,50,53,194

M

Magnetostrictive scaler,224,240 Manufacturer tolerance,99,108 Marginal ridges,166-173 Martensitic stainless steel,25,26

Maximum translation series,95,96,102,123,124

Meccaca Monkey,228 Mechanical Retention,42,46-48,50-

52,54,55,218

Mechanotherapy,107,109,126,130

Medium translation,95,96,102,119,124,125,137

Mesh diameter,44,45 Mesh gauge,44 Mesh number,44-46,50,267 Mesh type bases,48,50 Mesial offset,90,122,126 Mesial translation,95,96,124,125

Mesiobuccal cusp,84,88,91,92,97,98,123,127,156

Mesiobuccal groove,88,91,92

Mesiodens,161,162

Mesiodistal Crown tip,92

Mesiodistal position,153,154,156,157,183-186,194

Mesiolingual cusp,84,91,92,127 Metal injection molding,14-18,27,47 Metal sintered bases,48 Metallic luster,263 Micro mesh base,42

(II)

Microetched bases,42

Microleakage,192

Microretention,47,48,195,240

Mid-developmental ridge,92,93,154,156,158,165

Milling,14-18,20,21,37,47,194

Mini mesh base,42

Minimum Translation series,95,96,102,123-125

Moisture insensitive primer,192 Molar offset,88,90-93,98,127 Moment arm,66,69 Monobond plus,261 Monocrystalline brackets,35,37,38,55,

232,233,235,265

N

Nd:YAG,35,48,233,252

Nickel allergy,19,20,22,28,30,31,33 Non vital teeth,220,221

Notching,205,223

O

Occlusal plane,92,93,97-

99,105,106,112,117,127,129,133,135,

136,162,166,182

Open area percentage,46,47 Optimesh base,42 Ormesh base,42 Ortho bonding,271,272 Ortho Solo,261

Orthotronics,271,272

P

Passive self ligating

brackets,10,72,73,109,264

Pellicle,189

Peppermint oil,222 Perforated bases,42,43 Phosphoric acid,190,195,240

Photoablation,232,235

Photoetched bases,42,47

Photon,231

Piezoelectric scaler,224,240

INDEX

Pin and tube appliance,4 Plasma arc curing light,192 Plasma coated brackets,48,50 Plastic Brackets,14,19,31-34,51-53,68-71 Plastic injection molding,19,31 Plastic primer,51 PoGo polisher,247,250,253 Polyacrylic acid,191,222

Polycrystalline brackets,18,34-38,55,232-235

Polymer mesh base,51,54 Polyoxymethylene Brackets,31,32 Polyurethane brackets,31,32 Porcelain veneers,195 Power arms,77-79,81,94,95,99 Preadjusted edgewise

appliance,8,9,64,83,102,153,158

Precious metal brackets,21,30,31,51 Precipitation hardening,25,26 Prescription,9,10,15,22-24,61-63,67, 69,

83,87,90-96

Primer 31,32,51.190,191,199,260, 261, 270 Protective goggles ,194,195,222 Pulse mode ,231,234

Pumicing,189,190,199240,243,249-253

R

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

S

SAE,21

Sandblaster,251,252,266,267

Scaling,189,224,245,250,

Second order bends,62 Self etching primer ,190 Self ligating brackets ,9,10,72,109,

214,264,265

Separating medium ,196,197

Separators ,199 Shape of brackets,80 Siamese bracket,7 Side cutter,210,213,223 Silane coupling agent,50-

54,195,260,261,264,269

Silica coating,52,261,264,269, Silica lined slot,70 Silicon tray,196,197 Single mesh base,42,44,269 Single slot brackets,7,67

Sintering,16-18,26,35,36

Slip planes,218 Slot base,71,72,86,87,105,

110,116,117,208

Slot creep,32 Slot point,58,77,86,87,94,95,116 Slot rotation,116 So flex discs,247,248,253 Sodium bicarbonate,259,272 Soft tissue lasers,231,233,234

Soldered,2,4,7,13,162,189,256

Speed brackets,166 Standard brackets,61,69,95,100,

102,119,120,129

Steel burs,139,243 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

T

Thermal ablation ,232,235 Thermal softening ,232,234,235 Third order bends,63 Tip edge,10,65,67,79 Tip edge plus brackets,10,65,67

Tipping,4,10,64,65,123,129

Tipping springs,65 Titanium brackets,21,27-31,50,111

(III)

Torque in the Base,58,100 Torque in the face,58,59 Torque play,15,72,107,108,110 Torque zone,112 Torqueing springs ,63,79 Tribochemical method ,260,261 True twin brackets ,68,69 Tungsten carbide bur,244-253,261 Twin bracket,7,35,56,68,69,208 Twin wire appliance,6,7

U

Ultra pulse mode ,234

Ultrasonic cleaning ,257,258,262,264-266,273

Ultrasonic debonding ,22,224-227 Ultraviolet light ,233 Universal brackets ,6,7

V

Van der Waal forces ,227 Vertical groove ,93 Vertical Mid Scribe line,79 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 Wing method,19,205-210,212,214-217,

219,257,260

Wire bevel,108 Wire diameter ,44-46,267 Wire guidance,110,143,163,183,184

Z

Zirconia Brackets,36,38