Brackets in orthodontics / /certified fixed orthodontic courses by Indian dental academy


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Brackets in orthodontics / /certified fixed orthodontic courses by Indian dental academy

  2. 2. All contemporary fixed appliance arebased on the Angles design from the 20 th centaury “Father Of Orthodontist” 2
  3. 3. Pierre Fauchard’s Orthodontic appliance-1728 3
  4. 4. Dwinelles Jackscrew-1849 4
  5. 5. Angle’s Jackscrew 5
  6. 6. Angles Retraction screw 6
  7. 7. According To Angle- A standard appliance must have five important properties-1. Simple2. Stable3. Efficiency4. Delicate5. Inconspicuous 7
  8. 8. Historical perspective In 1907 - E-arch Four basic designs-1. Basic E arch.2. Ribbed E arch.3. E arch without threaded ends.4. E arch with hooks. 8
  9. 9. The E Arch applianceBasic E arch Ribbed E Arch 9
  10. 10. E Arch Without Treaded Ends 10
  11. 11. E Arch With Hooks 11
  12. 12. DrawbackDentition was enlarged in all dimensionsby tippingOnce the retention appliance wasdiscarded various degree of malocclusionresulted 12
  13. 13. Pin and tube-1910Bands were put on all theteeth with a vertical tube intowhich soldered pin from thearchwire was placed .Advantage-good axialcontrolDisadvantage -limited m-dcontrol-difficult 13
  14. 14. The Ribbon Arch-1915Brackets wereintroduced withappliance.Tube of the pin wasmodified to providevertically positionedrectangular slot.A ribbon arch of 10x20gold wire was placed inthis slot . 14
  15. 15. BRACKET-was introduced byBRACKET- DR E H ANGLE 1916THUROW-as an orthodontic attachmentsecured to a tooth for the purpose ofengaging an arch wire .As an attachment that serves to deliverthe necessary tooth moving forces . 15
  16. 16. Edgewise ApplianceAngle oriented the slotfrom vertical tohorizontal and insertedrectangular wire into it.This provided thesolution to the problemscaused by the previousappliance 16
  17. 17. Begg ApplianceThis was developed by Dr P.R.Begg 1956It utilizes the ribbon arch type bracketsand was manufactured to accept 016’round wireWire was held in position with the lockpins 17
  18. 18. Begg Appliance Bracket design – -modified ribbon arch bracket- .020 x .045 slot 18
  19. 19. Begg Appliance Lock pins –Safety lock pinsDouble safety pinHook pin 19
  20. 20. Evolution of the edgewise brackets Original angle bracket was made up of a soft gold with . 22 x .28 slot. It was .050 wide and was soldered to gold band material . Angle soldered gold eyelets in appropriate positions on the band. 20
  21. 21. To overcome this problem – two edgewise brackets were used on the same toothThis provide a good rotational control.Disadvantage-perfect alignment. 21
  22. 22. Twin BracketJoining together of two edgewise brackets“SIAMESE TWIN BRACKET”The space between two brackets wasapprox 0.050Initially for upper central incisors andmolars.Terminology was changed to -“TWINBRACKET”. 22
  23. 23. Twin Bracket They are available in four sizes-1. Extra wide2. Standard3. Intermediate4. Junior Solid bracket-posterior bracket 0.100’” wide in dimension. 23
  24. 24. Twin Brackets 24
  25. 25. Curved Base Twin BracketCurving of the base of the twin bracket toconform to the curvature of the canine andthe premolar teeth.Besides the advantage of twin bracketoffering rotational and greater axial controlit also incorporated what is termed as “ POSITIVE CONTROL” 25
  26. 26. Curved Base Twin Bracket 26
  27. 27. Rotational control of twin bracketThe actual mechanism is by deflection ofthe archwire.The more resilient the archwire the morereadily it can be tied into the twin bracket.However 100% control cannot be obtainedFinal 10% desired rotation has toaccomplished by additional means. 27
  28. 28. Lewis bracketThis was the next development forbringing about efficient tooth rotation.He soldered auxiliary rotation arm thatabutted against the bracket itself and thusoffered a lever arm to deflect archwire androtate the teeth.Present day lewis bracket is a one piecebracket with rotational wings which isequivalent to original edgewise bracketwith single width feature. 28
  29. 29. Regular Lewis Bracket 29
  30. 30. Lewis bracket Advantage –1. 100% desired tooth rotation .2. Overcorrection3. Error in bracket placement . Curved Lewis bracket advantage-1. Increase contact with band .2. Reduces trapping of the food. 30
  31. 31. Lewis bracketVertical slot lewis bracketfurther refinement wasdone by incorporating a 020x020 vertical slotAdvantage-uprighting spring to correctaxial inclination. 31
  32. 32. Steiner bracketThis bracket incorporated flexible rotationarms and therefore did not rely entirely onthe resiliency of archwire for tooth rotation.It uses a single width edgewise bracketand has the inherent advantage anddisadvantage of the same . 32
  33. 33. The Straight Wire Appliance Andrews classified brackets into three types-1. Non programmed appliance-a set of brackets designed the same for all tooth types ,relying totally on wire bending.2. Partly programmed appliance- a set of brackets designed with some in built features ,but always require some wire bending. 33
  34. 34. The Straight Wire Appliance3. Fully programmed appliance- a set of brackets designed to guide teeth directly to their goal positions with unbent wires. Standard brackets. Transition brackets. 34
  35. 35. Terminologies 35
  36. 36. Non Programmed Edgewise Bracket Feature 36
  37. 37. The Straight Wire Appliance Design shortcomings –1. Bracket base perpendicular to bracket stem.2. Bracket bases are not contoured.3. Slots are not angulated4. Bracket stem are of equal faciolingual thickness.5. Maxillary molar offset is not built in.6. Bracket sitting techniques are unsatisfactory. 37
  38. 38. The Straight Wire Appliance1. Bracket base perpendicular to bracket stem. -this feature causes problems of slot inclination and occlusogingival position 38
  39. 39. The Straight Wire Appliance2. Bracket bases are not contoured.- Occlosogingivally the base of a non- programmed brackets is flat . 39
  40. 40. The Straight Wire Appliance 40
  41. 41. Slots are not angulatedMesio distal 41
  42. 42. The Straight Wire Appliance3. Slots are not angulated- 42
  43. 43. The Straight Wire Appliance 43
  44. 44. The Straight Wire Appliance4. Bracket stem are of equal faciolingual thickness.- 44
  45. 45. The Straight Wire Appliance5. Maxillary molar offset is not built in. 45
  46. 46. The Straight Wire Appliance6. Bracket sitting techniques are unsatisfactory. Various authors have their own way of positioning the brackets.-Tweed recommends sitting brackets in specified number of millimeters from the incisal edge.-Holdaway advocates that the bracket sitting should altered according to the malocclusion 46
  47. 47. The Straight Wire ApplianceAccording to Jarabak bracket sites forinclination should be determined by theshape of the crown.Saltzman recommends except for themaxillary lateral incisor ,brackets shouldbe located in the middle third of the crown. 47
  48. 48. The Straight Wire Appliance1. According to Andrews suitable bracket site has three criteria- No interference with either gingiva or with opposing tooth. Angulation and inclination of the crown . Middle of each bracket site must share the same plane of surface when the teeth in the arch are optimally positioned. 48
  49. 49. The Straight Wire ApplianceFully programmed appliance-- Slot-siting feature- Convenience feature- Auxiliary feature 49
  50. 50. The Straight Wire Appliance Slot siting feature-Feature 1- mid transverse planes of the slot stem and crown must be the same.Feature 2-base of the bracket for each tooth type must have same inclination as the facial plane of the crown. 50
  51. 51. 51
  52. 52. The Straight Wire ApplianceFeature 4- mid sagittal plane of the slot stem and crown must be same.Feature 5 -the plane of the bracket base at its base point must be identical to the facial plane of the crown at the FA point.Feature 6 - base should match the m-d contour of the tooth. 52
  53. 53. 53
  54. 54. The Straight Wire ApplianceFeature 7 - the vertical component should be parallel to one another.Feature 8 – all slots point must have same distance between them and the crown embrasure line. 54
  55. 55. 55
  56. 56. The Straight Wire Appliance Convenience feature-.1. The gingival tie wings of the post Brackets extend farther laterally .2. Base are inclined .3. Facial surface of the incisor and canine brackets are designed to parallel their bases.4. In mandibular brackets the tie wings are designed with least amount occlusofacial prominence5. Bracket identification. www.indiandentalacademy.com56
  57. 57. Convenience feature- 57
  58. 58. 58
  59. 59. The Straight Wire Appliance Auxiliary feature –- Power arms- Hooks- Face bow tubes- Utility tubes- Rotational wings 59
  60. 60. The Straight Wire Appliance Fully programmed translation brackets- Are used when bodily movement of the teeth is required . If they are not available ,teeth will not be within 2˚ or 0.5 mm of where they should be at the conclusion of the treatment . They have all the qualities of the standard brackets plus few other feature . 60
  61. 61. The Straight Wire ApplianceCounterbuccolingual tip- a slot sittingfeature for maxillary molar thatcounteracts buccolingual tip duringtranslation and then overcorrect.Countermesiodistal tip –a slot sitingfeature that counteracts mesial or distaltipping during translation and thenovercorrects.Counterrotation – a slot siting feature thatcounteracts rotation during translation andthen overcorrects , 61
  62. 62. The Straight Wire Appliance Translation problems – Translation- “uniform movement of the body in a straight line”. However bracket is placed in wrong place in two ways-1. It is occlusal .2. It is located laterally . 62
  63. 63. The Straight Wire Appliance Translation problems 63
  64. 64. The Straight Wire Appliance Lever Effects Of An Optimal 64
  65. 65. The Straight Wire Appliance Translation solutions- lever 65
  66. 66. The Straight Wire Appliance Lever common to all edgewise brackets 66
  67. 67. The Straight Wire ApplianceCounterrotationSlot rotation plus mesiodistal slot length plusarchwire flex plus mesial or distal force equalscounterrotation and rotation overcorrection. 67
  68. 68. The Straight Wire ApplianceCountermesiodistal tipSlot angulation plus mesiodistal slot lengthplus power arm length plus activatedarchwire and 68
  69. 69. The Straight Wire Appliance Partly programmed brackets- By definition p p. brackets are the one which lack atleast one slot sitting feature because of which it would fail to fully direct each slot to its tooth slot site.1. Slot inclination .2. Slot angulation.3. Slot prominence.4. Horizontal base contour. 69
  70. 70. The Straight Wire Appliance •Counter mesio distal tip 70
  71. 71. The Straight Wire ApplianceCounterbuccolingual tip 71
  72. 72. The Straight Wire Appliance Translation bracket categories –1. Minimum translation brackets –requiring a translation of 2 mm or less2. Medium translation brackets – requiring a translation of more than 2mm but less than 4 mm3. Maximum translation brackets -requiring a translation of more than 4 mm. 72
  73. 73. 73
  74. 74. The Universal BracketDeveloped by Dr.Spencer R Atkinson --1928Appliance has undergone periodicrefinements without losing its essentialfeatures. Modified to improve its leverage androtational potential . 74
  75. 75. Design- -vertical hallow shaft with two lateral welding tabs -central shaft has two slot openings1. Horizontal – opening labially at gingival third2. Vertical –opens incisally near the base and extends gingival one third of the bracket height -. 75
  76. 76. Original Bracket 76
  77. 77. Five Archwire Combinations Available 77
  78. 78. The incisal slot can hold-.008-.016 roundor .008 x.020 up to .015 x .028 wire . - corrections of rotations ,leveling or torque.Gingival slot can only hold round wireranging from .008 - .016 -mesiodistal axial inclinations ,act as aguide when teeth are moved bodily inmesial or distal direction. 78
  79. 79. The 3-D Universal Bracket(1974) -Jorge Fastlicht 79
  80. 80. Comparison of Previous Universal Bracket with 3-D Universal 80
  81. 81. Six basic movements 81
  82. 82. Six basic movements 82
  83. 83. Conventional light Wire bracket and 3 - D Universal Bracket Easy ligation Use of two wires simultaneously . As the bracket is wide very light wires are used in initial stages. Improve rotation potential. More space inside the vertical shaft. 83
  84. 84. The 3-D Universal Bracket Advantage-1. Efficiency in leveling and aligning2. Permits bodily movement in m-d direction3. Retracts canine without tipping4. Torque automatically in most cases5. Individual torque is also easily achieved 84
  85. 85. Broussard BracketWas designed by “Grayford broussard”Modified edgewise bracket in which thereis addition of 0.0185 x 0.046 slot –toaccept 0.018 auxiliary wireBrackets are patented by the .Utilizes the two force technique. 85
  86. 86. Broussard Bracket Features –-quick wing-vertical slot-round corners, smooth surface- horizontal slot-special torque brackets.- 0,7 ˚,17˚,22˚-insert pin 86
  87. 87. Broussard Bracket 87
  88. 88. Broussard Bracket 88
  89. 89. Transition from .022 to .018 slot The use of rectangular wires in rectangular brackets was introduced by Edward Angle. The original appliance was designed for use with gold arch wires and had a 22 x 28 slot . In angels concept of treatment ,sliding teeth along the arch wires to close spaces was unnecessary 89
  90. 90. Transition from .022 to .018 slot At that time the appliance was designed to produce appropriate force and a reasonable range in torsion when gold arch wires were used Problem originated when steel wires replaced ? There was a need to redesign the edgewise 90
  91. 91. Transition from .022 to .018 slot Solution to this problem was obtained by .022 .018 91
  92. 92. Transition from .022 to .018 slot Using undersized wire in edgewise bracket is way by which friction can be reduced. Sliding teeth along the arch wire requires atleast 2 mil of clearance . 92
  93. 93. Concept Of Fully Preadjusted ApplianceReed Holdaway- made the first attempt toalter bracket slots in 1958.Second attempt in this direction was madeby Ivan LeeJoseph R Jarabak was first to combinetwo features in 1961 –Jarabak light wirebracket manufactured by Rocky MountainOrthodontics 93
  94. 94. Roths Prescription In 1976 –Ronald Roth published a report entitled “Five year clinical evaluation of the Andrews Straight Wire Appliance”. In 1979 roth introduced a bracket set up with his own modifications keeping in mind –1. Biologic consideration .2. Mechanical consideration. 94
  95. 95. Roths Prescription Roths rationale –1. With the appliance in place ,it is virtually impossible ,because of the bracket interference ,to position the teeth precisely into occlusion shown by non orthodontic normal sample2. After appliance removal ,no matter how well treated the patient may be ,the teeth will shift slightly from the position they occupied at the time appliance was removed. 95
  96. 96. Bioefficient BracketIt is a modification of preadjusted systemintroduced by Viazis.The bracket prescriptions were designedto overcorrect malocclusion and to make itpossible to work with the largest possiblewires from the start of the treatment . 96
  97. 97. Bioefficient Bracket Rationale behind the bracket design is-- maximum potential of any archwire is achieved when the largest possible wire is used. The archwire between a narrow single bracket will have less stiffness and greater flexibility . 97
  98. 98. Bioefficient Bracket The bracket is designed to fulfill following requirements-1. Conformity to the crown anatomy and gingival outline 98
  99. 99. Bioefficient Bracket2. Ease of use- Variability in the bracket positioning is usually attributable to improper mesiodistal or buccolingual placement of the slot 99
  100. 100. Bioefficient Bracket 100
  101. 101. Bioefficient Bracket3. Minimum friction 101
  102. 102. Bioefficient Bracket4. Tip control 102
  103. 103. Bioefficient Bracket5. Rotational control-narrow ,elongated configuration of the bracket ,with the wings moved towards the mesiodistal surface of the teeth provide maximum rotational control 103
  104. 104. Bioefficient Bracket6. Vertical slot6. High torque in the anterior brackets. 104
  105. 105. Vari Simplex DisciplineThe actual appliance was born in 1978. All the brackets used in this systempretorqued , preangulated and exhibit specific bracket base thickness for in/out compensations . 105
  106. 106. Vari Simplex Discipline Factors determining the design of the appliance-1. Size and shape of the teeth ,especially mesio distal width and curvature .2. Selection of proper bracket style to fit the size and the shape of each tooth .3. Accessibility of the tooth .4. Patient comfort . 106
  107. 107. Vari Simplex Discipline Factors defining the bracket system--Type of bracket-Placement positions-Angulations-Torque-In /out compensations 107
  108. 108. Vari Simplex Discipline Brackets used in vari simplex1. Twin bracket-- Used on large flat surfaced teeth.-Mini –Diamond bracket inrhomboid design.- Advantage –a) Flat surface .b) Easy accessibility .c) Mini twin bracket .d) Patient comfort. 108
  109. 109. Vari Simplex DisciplineTwin bracket on the lateral incisor areprovided with additional tie wing for easyinitial wire placement.Additional permanent hooks are presenton the lateral incisor 109
  110. 110. Vari Simplex Discipline2. Lang bracket-- Was invented by Dr Howard Lang- Used round surfaced teeth at the corners of the arch . Design--single bracket a flat rotational control wing-each wing has a circular hole .- Wedge shape in profile 110
  111. 111. 111
  112. 112. 112
  113. 113. Vari Simplex Discipline Reasons for using Lang bracket on cuspids-1. Twin bracket reduces the inter-bracket distance.2. Better rotational control.3. Full bracket engagement with a twin bracket is difficult on a round surfaced tooth.4. Prevents attrition on the maxillary cuspid. 113
  114. 114. Vari Simplex Discipline3. Lewis bracket-- They are used for large round surfaced teeth that are not at the curve of the arch - bicuspids .- Small flat surface teeth - mandibular incisors. 114
  115. 115. Vari Simplex Discipline Design –- Consists of fixed wing single bracket with built in labial curvature of the rotational wings .- This provides a three point contact .- Bracket is wedge shape in profile view 115
  116. 116. Vari Simplex Discipline Advantages of using fixed Lewis wing over flexible Steiner wing-1. Additional force .2. Save adjustment time.3. Edges of the Lewis bracket are less sharp .4. Breakages are less . 116
  117. 117. Vari Simplex Discipline Salient features-1. -3˚ torque on maxillary cuspid2. No torque in the second molar tube.3. -5˚ lingual crown torque in the mandibular incisors 117
  118. 118. 118
  119. 119. Creekmore Uni Twin BracketRationale –-Twin bracket offered better rotational control which the single bracket could not matchuntil the rotational wings were added-Still when a tooth is rotated badly and misaligned at the start of the treatment ,rotational wings of the single bracket will interfere with full engagement of the archwire . 119
  120. 120. Creekmore Uni Twin Bracket 120
  121. 121. Burstone Cuspid BracketBracket design--consists of a basic .022 x .028 edgewiseslot-additional .017 x .025vertical or horizontalauxiliary . 121
  122. 122. THE DUAL ENVIROMENT BRACKETIntroduced by –Schudy 1990Design was based on computer modelingUses the advantage of having smallerwires and greater intrabracket space. 122
  123. 123. BRACKET DESIGNLarge outer slot - 0.040” -0.030”Smaller inner slot - 0.018” -0.016” 123
  125. 125. The larger outer slot allows maximum archwire flexibility in the initial phases of thetreatment .The smaller inner slot accepts smallrectangular wires for maximum control inthe later stages of the treatment . 125
  126. 126. According to the author-1. Faster leveling of the arches with fewer arch wires changes. -larger posterior intrabracket space permit teeth to move easily2. Easier torquing of the teeth with less discomfort.3. Fewer permanent set in arch wires due to mastication. 126
  127. 127. Torque In Base Vs Face 127
  128. 128. Begg /Chun-Hoon“Original”Combinaton BracketsInterchangeability oftechniques,for transfercases or for retentivelabial rectangular archwireafter 3rd stage of lightwiretreatment.Ample room provided foredgewise ligature wire.Available in regular andcurved bases. 128
  129. 129. Begg /Chun-Hoon “Full Flanged”Combinaton BracketsModified version which offered gingivallyextended welding flanges to provide morewelding areaAlso allow archwire to rest completelywithin the bracket. 129
  130. 130. Kamedanized BeggThis was introduced by Dr Akira Kameda.He modified the Begg technique to complywith the demands of time and progress oftechnology .This was based on 25 yrs of clinicalexperience .The basic idea was to solve unfinishedand/or unstable parts of pure Beggtechnique. 130
  131. 131. Kamedanized BeggBasic design of the appliance was samewith few modifications .He introduced what was called as KBbuccal tube and torquing brackets .These according to the author werenecessary for carrying out the KBtechnique. 131
  132. 132. Kamedanized BeggIn 1983 , heintroduced torquingand reverse torquingbrackets .Built in torqueadjustments isobtained by raisingthe incisal or gingivaledge of the bracketbase away from thetooth surface. 132
  133. 133. Kamedanized Begg Advantage of using round buccal tube with a round wire .But it had its own pitfalls-1. Free tooth movement is possible ,but anchor molars tend to roll in.2. Correcting lingually inclined molars is difficult.3. Directing the forces of anchorage bends and bite opening bends is difficult. 133
  134. 134. Kamedanized BeggTo overcome thisproblem heintroduced -RibbonArch Buccal Tubes-1986 134
  135. 135. Kamedanized BeggIn 1992 JIOS –mentioned thatefforts are goingon to develop anew type of KBbracket with a builtin T-Pin. 135
  136. 136. Kamedanized BeggAlso labio lingualthickness of these KBBrackets are same asnon torque brackets,regardless of the of10 ˚ or 20˚built intorque. 136
  137. 137. Refined Begg ApplianceA – brackets used areTP-256-00,with adepth of .020 andheight of .045 137
  138. 138. Refined Begg ApplianceMolar tubes –Round molar tubes .036 and 6 mm length.Oval tubes .072 x .024 and 5mm length. 138
  139. 139. Refined Begg Appliance Combination tube(TP Lab)They consist of around gingival tubeof .036 and 6.2 mmlength.Rectangular .025 x .018 -5.5mm long 139
  140. 140. Refined Begg Appliance Built in adjustments1. Anti rotational brackets . 140
  141. 141. Refined Begg Appliance2. Built in torque 141
  142. 142. Refined Begg Appliance Other attachments –1. Hooks 142
  143. 143. Refined Begg Appliance2. Lingual buttons ,cleats and eyelets 143
  144. 144. Refined Begg Appliance3. Additional round tubes 144
  145. 145. Refined Begg Appliance Pins used in Refined Begg 145
  146. 146. Combination brackets 146
  147. 147. Modular Self Locking Appliance Introduced by –FOGEL AND MAGILL -1976 Key objective to treat greater number ,better ,faster easier ,at a lower cost and by using an appliance which can achieve the optimal biologic response. 147
  148. 148. Modular Self Locking ApplianceIt is a light wiresystem using a singlepivotal bracket or twinself locking lowfrictional attachments . 148
  149. 149. Modular Self Locking Appliance Insert bracket –Archwire chamberBeaksInsert slotSlot apexSeatstem 149
  150. 150. Modular Self Locking Appliance 150
  151. 151. Modular Self Locking AppliancePlacement of theinsert bracket- 151
  152. 152. Modular Self Locking Appliance Receptacle –available in three sizes- Small (.150”)- Medium (.180”)- Wide (.200”)- Three vertical slots are present which accommodate insert brackets and the auxiliaries 152
  153. 153. Modular Self Locking Appliance 153
  154. 154. Modular Self Locking Appliance Archwire play 154
  155. 155. Modular Self Locking ApplianceInsertion of wire intothe insert bracket 155
  156. 156. Modular Self Locking ApplianceRemoval of archwire 156
  157. 157. Modernized Begg –Combination TechniqueWilliam Thompson AJO –JUNE 1981The rationale was to develop a treatmentmechanics that uses the advantages ofboth BEGG and STRAIGHT WIRE at thesame time minimizing thedisadvantageous. 157
  158. 158. Modernized BeggThe appliance was aimed at achievinglight ,rapid tipping forces to correct grosschanges in the tooth position at one stagein the treatment. While more rigid andprecise appliance to be used in the laterstage of the treatment to producemaximum tooth detailing and occlusalintercuspation. 158
  159. 159. Modernized Begg Begg force Physiologic force system system-unipoint contact - muscle action-anchor bend - tooth morphology-archwire action - cuspal interlock-auxiliary - freeway & functional-tipping forces - occlusal forces-Intrusive forces - bone density 159
  160. 160. Modernized Begg Favourable characteristics of Begg-1. Rapid bite opening.2. Rapid ant. Alignment.3. En mass anterior retraction.4. Good anchor control.5. Ant. Root torque is unlimited.6. Predictable molar and incisor positions. 160
  161. 161. Modernized Begg Unfavourable characteristics-1. Post. Root torque is difficult.2. Three dimensional arch coordination is difficult.3. Maintaining rotations is difficult4. Maintaining upright and torque is difficult.5. Finishing intricacies is difficult. 161
  162. 162. Modernized Begg Favourable characteristics of SWA-1. Precision in arch coordination is routine.2. Precision intercuspation is routine.3. Buccolingual root torque is routine.4. Simplified finishing wires are routine .5. Minimal wire adjustments in finishing. 162
  163. 163. Modernized Begg Unfavourable characteristics –1. Rigid appliance due to interbracket distance.2. More friction with sliding mechanics.3. Additional supportive anchorage recommended.4. Segmental retraction of anterior teeth.5. Forward tipping of incisors in continuous wire leveling.6. Prolonged bite opening mechanics. 163
  164. 164. Four Stage Bracket Appliance design--combination bracket design-lower third of the bracket is a type 256 Begg bracket-upper two thirds is a .018 x .025 straight wire slot . 164
  165. 165. Four Stage Bracket 165
  166. 166. Four Stage Bracket 166
  167. 167. Four Stage Bracket 167
  168. 168. Four Stage BracketBegg procedures should be carriedcompletely through stage I and stage IIand partly through stage III .When the edgewise slots are parallel toeach other Begg portion of the treatmentis ceased . 168
  169. 169. 169
  170. 170. Four Stage BracketThe author claims that the clinical use ofthis combination appliance has showngood results .He believes that there is a possibility offurther improvement in design andtechnique of this appliance. 170
  171. 171. THE BEDDTIOT APPLIANCE Begg Edgewise Diagnosis-Determined Totally Individualized Orthodontic Technique. - RICHARD HOCEVAR-1985The appliance offered the capacity to employ the principles and features of the Begg and edgewise mechanism in specific situation in which they are most advantageous. 171
  172. 172. BRACKET DESIGNLingual narrow ,single width-0.050”1.3mm Edgewise Bracket 2 slots-Horizontal-.022(height)x.028(depth)Vertical- .020 x .020Archwire slot are torque with indicatorgingival groove –lingual root torqueOcclusal groove-lingual crown torque 172
  175. 175. Except for the torque the brackets areidentical and interchangeable .There are a total of five brackets whichdiffer only in the torque-0˚,5˚,10˚,15˚.Buccal tubes -4.5 mm - .022 x .02825˚ - lingual crown torque for lower 10˚ - for the upper molars. 175
  176. 176. Characteristic feature- In cases of deep bite or severe anchorage cases – additional rectangular tube is is placed diagonally at an angle of 15˚,with its mesial end pointing gingivally. Advantage –1. Increase the anchorage.2. Built in anchor bend. 176
  178. 178. Tip EdgeIntroduced by Peter Kesling based on hisexperiences with differential toothmovement and thesis written in 1968Based on the rationale that each tooth hasto tip freely either measily or distally –notin both directions .Keeping this in mind the appliance wasdesigned to provide all the benefits ofdifferential tooth movement plus predetermined degree of final crown tip andtorque 178
  179. 179. Tip 179
  180. 180. Tip Edge Basic design consist of- -removal of diagonally opposed corners of a conventional edgewise slot-slot size is .022 x.028-lateral extensions or wings-vertical slot .020 x.020- deep grooves 180
  181. 181. Tip 181
  182. 182. Tip 182
  183. 183. Tip 183
  184. 184. Tip 184
  185. 185. Tip Edge Molar tube are designed – .036 round gingival tube .022 x .028 occlusal tube They are available with –1. Extraction and non extraction kits2. Torque in base /face3. Over rotational bracket4. With in/out compensations5. Positing jigs6. Tip edge rings. 185
  186. 186. Tip 186
  187. 187. Tip 187
  188. 188. Tip 188
  189. 189. Tip Edge Advantage over original edgewise –1. Adversely tipped teeth2. Anchorage control Advantage over ribbon arch-1. Inout compensation.2. Prevent distal crown tipping of cuspid 189
  190. 190. Combination Anchorage TechniqueClinical experience with the combinationbrackets provide extensive knowledgeregarding the expanded capabilities of thetechnique.What was originally believed to bemodernized Begg was actually a truecombination anchorage technique. 190
  191. 191. Combination Anchorage Technique The original combination brackets proved to be-- Bulky .- Weak.- Aesthetically unattractive.- Problems with pinning rotations- Slot closure- Occlusal interference. 191
  192. 192. Combination Anchorage Technique The bracket design was changed –- It had a .022 x .035 gingival or ribbon arch slot.- .018 x .025 .022 x .028 edgewise slot.- Enclosed vertical slot . 192
  193. 193. Combination Anchorage Technique 193
  194. 194. Combination Anchorage Technique 194
  195. 195. Combination Anchorage Technique 195
  196. 196. Combination Anchorage Technique Brackets are available with colour coding for easy identification . - maxillary –red mandibular-blue- Varying degree of torque for the anterior brackets.- Molar attachments with convertible molar tubes.- Redesigned pin slot . www.indiandentalacademy.com196
  197. 197. Combination Anchorage Technique a) Phase III retention pin b) Phase I and II retention pin c) Tandem, hook pin d) Bypass clamp 197
  198. 198. Begg – Ribbon Arch Combination SystemIntroduced by Nikhil Vashi JIOS-Jan 1991Appliance was designed to combine theadvantages of the BEGG and theEdgewise and the Preadjusted Appliance 198
  199. 199. Begg – Ribbon Arch Combination SystemDesign-A gingival ribbon wise slot (018 x 027).An incisal or occlusal horizontal slot (020 x020)Two vertical slot for lock pins or ligaturewire 199
  200. 200. Begg – Ribbon Arch Combination System BRACS 200
  201. 201. Begg – Ribbon Arch Combination SystemMolar tube is rectangular ribbon wise for ribbonarch and has a 6˚ offset . 201
  202. 202. Begg – Ribbon Arch Combination SystemDifferent movements can be obtained just bytying or pinning the archwire differently. 202
  203. 203. Begg – Ribbon Arch Combination System 203
  204. 204. Begg – Ribbon Arch Combination SystemBite opening is done with around wire like016 ss.In the next phase retraction of anteriors isdone by free or controlled tipping or bybodily translation.In the last phase – initially a 016 x016 or016 x 022 can be used and then 017 x025 and 018 025 ss can be used for finalfinishing . 204
  205. 205. Begg – Ribbon Arch Combination System BRACS has following advantages-1. Rapid differential movements of teeth with better control and less friction.2. Helps in proper finishing of the case.3. Need for patient co-operation is minimal.4. Eliminates the need for heavy elastics .5. Eliminates complicated and unstable stage III mechanics.6. Reduced the treatment duration. 205
  206. 206. “J” bracket- Begg Combination Bracket Introduced by Dr Jayade –JIOS 1991 Requisites of a good combination –1. It must be capable of delivering all the advantages of the Begg appliance and at the same time eliminate all its disadvantages .2. It must permit the incorporation of SW concept of finishing without its disadvantages.3. Should have more than one slot .4. Should be economical . 206
  207. 207. “J” bracket- Begg Combination Bracket Advantages of multiple slot brackets over single bracket-1. Diametrically opposite treatment requirements.2. Possibility of applying forces to the teeth at different areas .3. Switching slots help in altering or reinforcing anchorage.4. Use of segmental /tandem wires. 207
  208. 208. “J” bracket- Begg Combination Bracket Rationale of orientation of slots in the new design-- All bracket slots are cuboidal. 208
  209. 209. “J” bracket- Begg Combination Bracket Movements which remain unaffected by this orientation of the slot –1. Intrusion or extrusion .2. Labio lingual crown tipping using round wire3. Labio lingual root movement 209
  210. 210. “J” bracket- Begg Combination Bracket Movements which are affected by changing the slot orientation –1. Mesiodistal crown tipping (slot height).2. Rotational control (slot depth) 210
  211. 211. “J” bracket- Begg Combination Bracket Disadvantage of the twin slot arrangement- Drastically reduce mesio-distal tipping. Decrease in the inter bracket wire span. 211
  212. 212. “J” bracket- Begg Combination Bracket Net effect of changed orientation of the slot-1. Permits optimum mesio distal crown tipping .2. Affords good rotational control.3. Allows to fully utilize torquing abilities of rectangular wire.4. Partly overcomes disadvantages of twin bracket configuration. 212
  213. 213. “J” bracket- Begg Combination Bracket “J” bracket configuration –1. The single slot(.024 ht x .1 mm wide). This permits easy tipping to adequate extent in initial stages faces horizontally.2. The twin slots(.032ht x .018 depth, placed 3mm apart) 213
  214. 214. “J” bracket- Begg Combination Bracket 214
  215. 215. “J” bracket- Begg Combination Bracket Advantages-- Better rotational control.- Possibility of using uprighting springs and auxiliaries along with round .018 round base wire .- Possibility of using full torquing potential of rectangular wire upto 018 x 025 215
  216. 216. “J” bracket- Begg Combination Bracket3. Using both slots together when necessary ,advantage of the combination bracket can be derived . 216
  217. 217. “J” bracket- Begg Combination Bracket Molar attachment – When only first molar are available for anchorage molar band carry gingival rectangular tube in ribbonwise orientation and a round tube occlusally . When both 1st and 2nd molar have to be utilized 2nd molar will have such a combination tube and 1st molar twin rectangular attachment gingivally ,and an occlusal round tube. 217
  218. 218. Brackets Used In Lingual Orthodontics 218
  219. 219. Bracket Design For Lingual OrthodonticsLingual light Wire Technique-Stephen FPaige –Aug 1982 JCO.With the advent of bonding of attachmentsdirectly on the teeth ,it became possible tobond brackets directly on the lingualsurface .Fujita who confirmed that orthodontictreatment with brackets placed on thelingual was possible . 219
  220. 220. Bracket Design For Lingual Orthodontics Bracket design criteria –1. Decreased interbracket distance –narrow mesiodistally.2. Because of decreased bracket width ,mesiodistal root control becomes more difficult –vertical slot for arch auxiliaries . 220
  221. 221. Bracket Design For Lingual Orthodontics3. Topography of the lingual surface vary to a great deal-until future advances make precision direct bonded placement ,”straight wire” approach to bracket design appears impractical. 221
  222. 222. Bracket Design For Lingual Orthodontics4. Ease of insertion, ligation and removal of archwire – incisal or occlusal placement of arch wire . Begg bracket fulfils all these criteria 222
  223. 223. Bracket Design For Lingual OrthodonticsUnipoint combination bracket (Unitek). 223
  224. 224. Bracket Design For Lingual Orthodontics Molar tubes- Conventional oval tubes with mesiogingival hook (Unitek 0456-516). 224
  225. 225. Bracket Design For Lingual OrthodonticsMethods of ligation- 225
  226. 226. Bracket Design For Lingual OrthodonticsLingual Begg light wire technique –PeterK-J Yen Nov 1986 JCO.They developed a technique that usedregular Begg light wire and labial brackets 226
  227. 227. Bracket Design For Lingual OrthodonticsRegular 256 Begg brackets were usedLower labial incisors were used for bothupper and lower incisorsUpper lateral incisor labial brackets wereadapted to cuspidsCurved upper cuspid labial brackets wereused for bicuspids. 227
  228. 228. Bracket Design For Lingual OrthodonticsTo provide properinterbracket distancein stage I vertical slotsof the bracket wereincisally .For stage II and IIInew set of bracketswere bonded withvertical slots directedgingivally 228
  229. 229. Bracket Design For Lingual Orthodontics In Aug 1989 AJO-Thomas Creekmore An acceptable lingual orthodontic appliance system must include the following key elements- It should align teeth from the lingual side as efficient as from the labial side. A mean of positioning the bracket precisely to create a “near” SWA on the lingual side. 229
  230. 230. Bracket Design For Lingual Orthodontics  A consistent and accurate indirect bonding  A selection of preformed archwires with canine and premolars offsets.  Specially designed pliersThe appliance that satisfy all the above requisites is the “conceal system” developed by the Unitek corp. 230
  231. 231. Characteristic feature-The foundation of the design is theopening of the wire slot to the occlusalaspect rather then to the lingual aspect. 231
  232. 232. Bracket Design For Lingual OrthodonticsFirst 1 mm of the molar tube opens to theocclusal aspect. 232
  233. 233. Bracket Design For Lingual OrthodonticsThe occlusal approach had potential problem - ligation - design for adequate tip 233
  234. 234. Bracket Design For Lingual OrthodonticsConceal brackets are designed aroundUnitwin Bracket 234
  235. 235. Bracket Design For Lingual OrthodonticsBracket has three different slot widths for threedifferent functions of tip (a-b) , torque (e-f),rotation (c-f or e-d). 235
  236. 236. Bracket Design For Lingual Orthodontics 236
  237. 237. Bracket Design For Lingual OrthodonticsDifficult challenge of small working space –anterior brackets have Y configuration with asingle tie wing projecting gingivally and twin tiewing projecting occlusally 237
  238. 238. Self ligating Brackets The first self ligating bracket was developed by DR .Jacob Stolzenberg in early 1930’s. Design – - bracket had a flat head screw seated snugly in a circular ,threaded opening in the face of the bracket.- The horizontal screw could be loosened or tightened 238
  239. 239. Self ligating Brackets 239
  240. 240. Self ligating Brackets In 1971 Dr Jim Wildman developed the Edgelok bracket . Design –- Bracket had a round body with a rigid labial sliding cap- This design made the bracket “passive” in its interplay with the arch-wire.- This was the first “passive” self ligating bracket ,and first to enjoy any sort of commercial success. 240
  241. 241. Self ligating Brackets 241
  242. 242. Self ligating Brackets About 2 years later Dr. Franz Sander introduced the Mobil-lock bracket Design-- Semi circular locking mechanism- A special tool was used to rotate the lock into its closed or open position 242
  243. 243. Self ligating Brackets 243
  244. 244. Self ligating Brackets“Speed” bracket introduced by Dr HerbertHanson in 1976 and became available in themarket in 1980.Stands for-Spring loadedPrecisionEdgewiseEnergyDelivery 244
  245. 245. Self ligating Brackets 245
  246. 246. Self ligating Brackets Design –1. The bracket body – prior to welding -four slots -shallow triangular groove - welding flange - no gingival tie wing 246
  247. 247. Self ligating Brackets .018 x .025 horizontal slot .017 x.017 horizontal slot . Vertical spring slot. Instrument access slot.- Shallow transverse groove 247
  248. 248. Self ligating Brackets 248
  249. 249. Self ligating BracketsSpring clip-Highly resilient spring clip made up of .005x .060 or .005 x.072 ss strip .Curved occlusal portion has an angle ofwrap of 217˚ 30 minutes when free fromexternal stresses .Prior to insertion spring arms converge atan angle of 37˚ 30 minutes. 249
  250. 250. Self ligating Brackets 250
  251. 251. Self ligating BracketsThe bonding base-When viewed from the labial mesial anddistal edges of each of the welding padare parallel to each otherGingival edge is curved gingivally in formof a semi-ellipse. 251
  252. 252. Self ligating Brackets Bracket –spring assembly- when the spring is in the slot close position ,its arms are held apart so as to reduce their angle of convergence by atleast 2˚-This causes elastic deformation 252
  253. 253. Self ligating Brackets Rotational control about three axes –1. The occlusogingival axis (rotations)2. The labiolingual axis tipping)3. The mesiodistal axis (torquing) 253
  254. 254. Self ligating Brackets 254
  255. 255. Self ligating Brackets 255
  256. 256. Self ligating BracketsHelps the operator in saving as much as 5minutes per arch change .It permits a high degree of precision inthree dimensional control of tooth .Well suited for sliding mechanics .Capacity to store relatively large amountof energy for release at desirably slow 256
  257. 257. Self ligating BracketsLater in 1986 Dr Erwin Pletcher introducedActiva bracketLike the straight wire appliance it is a fullyprogrammed appliance with specific toothpositions built into a special bracket foreach tooth. 257
  258. 258. Self ligating BracketsIt has a horizontal slot of .022” x.022”Vertical slot of .020 x.020”Bracket has a inflexible ,curved arm thatrotates occluso-gingivally around thecylindrical bracket body.All brackets are colour coded .The latches close to the gingival . 258
  259. 259. Self ligating Brackets 259
  260. 260. Self ligating Brackets Advantages-1. Vertical slot can be used to engage hooks, rotational and uprighting spring.2. The bracket are smaller than the twin or mini bracket.3. Friction is significantly reduced.4. There is 100% compatibility with other straight wire bracket.5. Time factor.6. Teeth move faster and with less force. 260
  261. 261. Self ligating Brackets In 1995 Dr Wolfgang Heiser introduced the -Time- bracket. Design-- Rigid ,curved that wraps occlusogingivally around the labial aspect of the bracket body- A special instrument is used to pivot the arm gingivally into the slot open position or occlusally into the slot closed position. 261
  262. 262. Self ligating Brackets 262
  263. 263. Self ligating BracketsNext to follow was The Twin Lock bracketwhich was introduced in1998It had a flat ,rectangular slide ,housedbetween the tie wing of an edgewise twinbracket.Slot is moved with a universal scalar 263
  264. 264. Self ligating Brackets 264
  265. 265. Self ligating BracketsBetween 1996 and 1999 Dr DwightDamon introduced the Damon SL I andDamon SL II brackets.The basic difference is that the first had alabial cover that straddled the tie wing,while the second incorporates a flat ,rectangular slide between the tie wings . 265
  266. 266. Self ligating Brackets 266
  267. 267. Self ligating Brackets 267
  268. 268. In-Ovation BracketIt is self ligating bracket system consistingof a twin bracket for rotational control andhas an active clip for seating arch wire .Manufactures claim that the bracketdesign not only combines all the importantfeatures of an effective self ligating system,it goes even further to provide the highestlevel of versatility ,function and comfort. 268
  269. 269. In-Ovation Bracket 269
  270. 270. In-Ovation BracketLow profileFour full tie wingsSlot blockerHorizontal V SlotCompound contoured baseTorque in base 270
  271. 271. In-Ovation Bracket 271
  272. 272. In-Ovation BracketReduced resistanceReduced chairtimeEnhanced hygieneEnhanced interbracketdistance 272
  273. 273. In-Ovation Bracket New instruments which are designed to make in-ovation brackets more efficient1. Beaver Tail2. V tool3. Positioner 273
  274. 274. In-Ovation Bracket 274
  275. 275. In-Ovation Bracket Super mesh 275
  276. 276. In-Ovation Bracket Bite Ramps 276
  277. 277. Friction Free BracketWas introduced by Kazuto in early1990”s J Jap Orhtod.Basic idea of the design was to reducefriction between the bracket slot and thearchwire.So that tooth movement could beaccomplished with lighter forces . 277
  278. 278. Friction Free Bracket 278
  279. 279. Friction Free BracketFrictional force =acting tangentially at thecontact surface is the product of a verticalload and coefficient of friction 279
  280. 280. The Next Generation :Straight Wire ApplianceThis concept was introduced byCreekmore and Randy in 1993 AJOFrequently anticipated results are notachieved by using a preadjustedappliance and straight wire . 280
  281. 281. The Next Generation :Straight Wire Appliance There are atleast five reasons –1. Inaccurate bracket placements –a mean of .34 mm error in vertical plane and 5.54˚ for angular placement is observed - Balut et.al2. Variations in tooth structure3. Variations in ant –post and vertical jaw relations require variations in the position of the max and mand incisors. 281
  282. 282. The Next Generation :Straight Wire Appliance4. Need for overcorrection5. Mechanical deficiencies of the edgewise appliance –force application away from CRes. -play between arch wire and slot. -force diminution. 282
  283. 283. The Next Generation :Straight Wire Appliance THE SLOT MACHINE 283
  284. 284. The Next Generation :Straight Wire Appliance 284
  285. 285. The Next Generation :Straight Wire Appliance Advanced Preadjusted Appliance FabricationTorque –with the use of an incisor TorqueTemplate (Creekmore Enterprises ).Tip -can be adjusted taking inconsideration the anchorage requirement .Rotations- rotations can be accuratelymeasured by using rotational guides 285
  286. 286. The Next Generation :Straight Wire ApplianceHeight – more precise height measurements are possible All this requires proper planning of individual tooth movement so as to determine exact amount of torque ,tip , rotation and height parameter for each tooth 286
  287. 287. The Elan and Orthos SystemThis was introduced by Craig AndreikoThese are two appliance system thatrepresent the first modern CAD/CAMtechnology for appliance design inorthodontic field. 287
  288. 288. The Elan and Orthos SystemElan is first system to integrate treatmentplan and appliance for a specific patient.Elan system begins with digitizing theskeletal and dental entity of the patient .The system then proceeds to design anocclusion based on the practitionerstreatment plan and on algorithmsdeveloped to mate the three dimensionalpositioning of the dentition to the skeletalframework. 288
  289. 289. The Elan and Orthos SystemBase on all these the system designs andfabricate brackets ,wires and bracketpositioning devices that are essentiallyreversed engineered from the desired finalresults for that individual patient . Begin with the end in mind 289
  290. 290. The Elan and Orthos SystemMandibular brackets are place asocclusally as possible for hygiene andassuring clearance from the buccal cuspMaxillary bracket are placed fairly centraldue to absence of interference .Currently the system is available only inthe twin bracket configuration with both018 and 022 . 290
  291. 291. The Elan and Orthos System Advantages –1. Highly individualized treatment .2. More efficient.3. Fewer appointments .4. Allows the operator to spend more time on designing treatment plans and less time bending wires . 291
  292. 292. The Elan and Orthos SystemOrthos system is a new averageprescription and appliance design basedon computer analysis of more than 100cases derived from the Elan technology.It consist of a coordinated system ofbrackets ,buccal tubes and wires . 292
  293. 293. The Elan and Orthos SystemPrescriptions incorporated in theappliance design are meant for aparticular race .Asian version of orthos will soon beavailable .Although there are many differences mostsignificant are in the mandibular posteriorteeth and maxillary anterior teeth. 293
  294. 294. Evolution of Brackets Based On Materials 294
  295. 295. Angles EraInitially all the attachments were made innoble metals and their alloys - - gold (75%) -platinum -iridium -silver 295
  296. 296. Angles Era Advantage –1. Esthetically pleasing2. Corrosion resistant. Disadvantages –1. Lack of flexibility2. Tensile strength. 296
  297. 297. Angles Era In 1887 Angle tried replacing the noble metals with German silver Angle later varied its composition –so that it could be used – Jack Screw -Traction ScrewStainless steel replaced all these materials 297
  298. 298. Metal Brackets Advantages of the metal brackets -1. Excellent strength.2. Friction .3. Smooth surface finish. Disadvantages of the metal brackets –1. Corrosion2. Biocompatibility3. Esthetics 298
  299. 299. Plastic brackets With the introduction of new materials like polycarbonates and polysulfones it was possible to manufacture esthetic brackets Advantage –1. Esthetically acceptable when compared to steel. 299
  300. 300. Plastic brackets Disadvantages-1. Staining and discoloration.2. Poor dimensional stability (lack the strength to resist distortion and breakage).3. Undue friction between the bracket slot and the wire made sliding mechanics difficult.4. Need for compatible bonding resin. 300
  301. 301. Plastic bracketsTo some of the disadvantages plastic bracketswith metal inserts were introduced 301
  302. 302. Ceramic bracketsThese were introduced in early 1980’s.Earlier brackets were opaque and bulkyBy the end of the decade – high purityalumina was introduced which made thesebrackets clear as compared to earlierones. 302
  303. 303. Ceramic brackets 303
  304. 304. Ceramic brackets Advantages of ceramic bracket over plastic-1. Stain resistant,2. Durable3. Good dimension stability.4. Custom molded for individual teeth.5. Allowed incorporation of the SWA feature 304
  305. 305. Ceramic brackets Earlier ceramic brackets were made of alumina-1. Brittle –fracture was common . Rounded and smooth design was given 305
  306. 306. Ceramic brackets Later Zirconia brackets were introduced -- Surface hardening treatment was done- Lower Youngs modulus- Higher overall strength Disadvantage – increase coefficient of friction. 306
  307. 307. Ceramic bracketsPolycrystalline alumina-American ,Dentarum Signature,Rocky MtnPCA with metal slot- Unitek ,ClarityMonocystalline alumina-A Co,StarfirePolycrystalline Zirconia- Yamura,Toray 307
  308. 308. Ceramic bracketsCeramic Bracket With Metal Insert 308
  309. 309. Ceramic brackets Disadvantage-1. Fracture .2. Hardness .3. Bulkier .4. High friction .5. Enamel damage at the time of removal. 309
  310. 310. Composite BracketTwo or more polymersThese have properties medium betweenthose of the constituents so maerialsshould be so chosen that the property ofone constituent improves the deficientproperty of others 310
  311. 311. Composite Bracket 311
  312. 312. Composite Bracket 312
  313. 313. Titanium bracketsAlternative to stainless steel- in patients who had sensitivity to Ni.Advantage--CAL manufacture- superior to ss in sliding mechanism.- excellent biocompatibility.-small size-matte finish blends better with the tooth.-low thermal conductivity-no metallic taste. 313
  314. 314. Titanium brackets Rematitan Bracket 314
  315. 315. Titanium bracketsDisadvantage –-difficult to fabricate-not as esthetic as stainless steel 315
  316. 316. Gold BracketsBiocompatibleEsthetics 316