bracket positioning and resets/ cosmetic dentistry courses

Bracket positioning and resets: Fivesteps
to align crownsand rootsconsistently
Sean K. Carlson, DMD, MS, & Earl Johnson, DDS
AJODO
2001
JOURNAL CLUBJOURNAL CLUB
www.indiandentalacademy.comwww.indiandentalacademy.com

 Orthodontists strive for accurate bracket positioning
because it makes achieving a superior occlusion easier.
 Whether one uses a direct or an indirect bonding
technique, the initial appliance placement typically
includes some bracket-positioning errors.
The clinician either corrects these errors during
treatment or tediously repeats archwire bends to
compensate for the misplaced brackets.

Different viewson bracket placement
Angle said that the best position of the band is where it
fits the best. And then if possible, the bracket should be
placed at the center of the labial surface.
Beggs has given certain range of distances from the
incisal edge or cuspal tip at which the brackets can be
placed. The brackets are placed gingivally as we move
posteriorly. They are centered on the labial surface
mesiodistally.
Ricketts advocated the use of marginal ridges as
guidelines for band and bracket vertical positioning.
Andrews introduced the bracketing technique of keeping
the vertical tie wings parallel to the long axis and the
middle of the slot base should be the mid point of the
clinical crown.

 A well finished casehasproper alignment of crowns, rootsand
leveled Marginal ridges.
 With Preadjusted edgewiseappliance, theposition of bracket
determinesthetooth’sfinal tip, torque, height and rotation.
 Poor bracket positioning can render even themost customized
prescription ineffective.
 Even after extracare, somebracket positioning errorsmay be
incorporated dueto themalocclusion itself or theoperator
error.
 Theseerrorsneed to beidentified early in thetreatment and
rectified.

A 5– STEPPROTOCOLFORACHIEVING CROWNA 5– STEPPROTOCOLFORACHIEVING CROWN
&ROOTALIGNMENT&ROOTALIGNMENT
TEP 1 : INITIAL BRACKET POSITIONING
TEP 2 : PRIMARY EXPRESSION OF BRACKET PRESCRIPTION
AND POSITION
TEP 3 : RESET EVALUATION
TEP 4 : RESET APPOINTMENT
TEP 5 : SECONDARY EXPRESSION OF BRACKET PRESCRIPTION
AND POSITION

STEP 1 : INITIAL BRACKETSTEP 1 : INITIAL BRACKET
PLACEMENTPLACEMENT
4 IMPORTANT ELEMENTS
Baseadaptation
Rotational position
Vertical position
Slot angulation

Vertical position
•Use well fitted molar bands as the benchmark
for the rest of the appliance.
•Position all the posterior brackets so that the
the distance from the slot and marginal ridges
is same for all.
•Anterior brackets should be positioned
on the basis of the posterior brackets.
•Canine and premolar brackets are
equidistant from cusp tips.
•Upper incisors are bracketed so that
they establish proper incisal relationship.
•Lower incisors are placed equidistant from
edges.
•Do not use worn or fractured edges as guides
for bracket positioning. www.indiandentalacademy.comwww.indiandentalacademy.com

Slot angulation
 Determine the desired slot angulation by
evaluating the position of the roots.
 Use IOPA as the guide for slot angulation.
 If the root is well aligned, then slot
angulation is neutral.
 If the root needs correction, then incorporate the
necessary correction in angulation.

STEP 2 : PRIMARY EXPRESSIONSTEP 2 : PRIMARY EXPRESSION
OF BRACKET PRESICRIPTIONOF BRACKET PRESICRIPTION
• The goal is to completely express the bracket
prescription thru leveling and aligning.
• If any severe error is noted then reposition it now during
light wire stage.
• Minor ones are done more efficiently during reset
evaluation stage.
• Now fill the slot completely before reset evaluation stage.
Authors recommend .018 x .018 Sentalloy in .018 slot.
• Allow at least 4 – 8 weeks for full expression.

STEP 3 : RESET EVALUATIONSTEP 3 : RESET EVALUATION
• Involves both clinical and radiographic
evaluation.
• For most patients reset evaluation can
take place within 6 months of active Rx.
• Clinically examine the brackets for all the
elements of step 1.
• Advise root paralleling IOPA series.

Special Patient Chart
 – poor base adaptation
MO / DO – rotational deficiency
I – intrusion needed
X – Extrusion needed
M – root apex needs to be moved mesially
D – root apex needs to be moved distally

STEP 4 : RESETSTEP 4 : RESET
APPOINTMENTAPPOINTMENT
• By this time the tooth – tooth relationships have
greatly improved.
• There is improved visibility of facial surface.
• Perform debonding, debanding, bracket & tooth
preparation, rebonding & rebanding.
• After bonding & cementation, engage 0.018 x
0.018 Sentalloy .
• Use a lighter wire if the change in one or more
brackets was severe.

STEP 5 : SECONDARYSTEP 5 : SECONDARY
EXPRESSIONEXPRESSION
OF BRACKET PRESICRIPTIONOF BRACKET PRESICRIPTION
• Secondary expression is complete within 6-8
weeks.
• Amount of time depends on the severity of
original positioning errors.
• After secondary expression, place the finishing
wire.
• At this stage the orthodontist can be sure that
root alignment has been achieved and no further
adjustment of root tip will be needed.

SUMMARYSUMMARY
• Protocol that addresses the errors in
bracket positioning is presented.
• This reduces the amount of arch wire
adjustments needed to achieve ideal tooth
positions.
• Reduces Rx times and gives superior
results.

THANK YOUTHANK YOU

bracket positioning and resets/ cosmetic dentistry courses

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