This document discusses various techniques for positioning orthodontic brackets, including: 1. Standardized methods that use gauges to measure from tooth edges. 2. Andrews' FACC method which uses the central lobe of each tooth crown. 3. Individualized positioning that varies torque, angulation, and position for each tooth. 4. Progressive positioning by Pitts which places brackets more gingivally from posterior to anterior. It also discusses bracket positioning considerations and modifications for specific tooth anomalies, malocclusions, and treatment plans.

1. Dr 3la2 al-Ibrahimi
JRMS
5-2017

2. Refinement of tooth position can be achieved
by:
1. Arch wire adjustment
2. Arch wire auxiliaries
3. Modifications to bracket position.
** planning bracket position must be
considered at the outset of treatment .

3. Techniques of bracket positioning
 Standardized method
 FACC
 Individualized bracket positioning
 Progressive positioning by pitts
 Mid-point of the crown

4.  Standardized method:
-with original edgewise
-standard measurement using a gauge from
incisal or occlusal edge irrespective of tooth
size.
-wire bending was needed in any case.

5.  FACC
-by Andrews
-is for all teeth except molars ; the most
prominent portion of the central lobe on each
crown’s facial surface
-for molars ;the buccal grove that separates
the two mesiobuccal cusps.
-the FA point is the midpoint of the FACC.
-difficult to obtain accurate vertical
positioning.

6.  Individualized bracket positioning
- Variation in occluso-gingival position (more
gingival in AOB & more occlusal in deep bie
caes).
- Variation in torque application.
- Variation in M-D position.
- variation in angulation:
1. in pseudo transposition overangulate
the brackets to prevent tipping.
2. parallelism of roots before implant
placement.

7.  Progressive positioning by Pitts
- Brackets are placed more gingival (posterior-
anterior progressive positioning) than normal.
- Using the M-D contact point of the teeth as a
reference line.

8.  Mid-point of the crown.
- By McLaughlin and Bennet
- Using bracket positioning charts
- They determined ideal bracket placement
positions based on the midpoint of clinical
crown and found minor deviations of the
centers of clinical crowns on:
- upper premolars and second molars
- lower canines and first molars.

9.  Teeth which are unerupted or significantly
out of the arch form.
 Deep bite with distally inclined canines.
 Deep bite in which the upper incisors
interfere with bracket placement on lower
incisors . This can be dealt with by:

10. Low angle cases:
1.Removable Anterior bite plates (only in growing
pts unless clockwise mand.rotation is required.
2. Placement of coloured adhesive or bite turbo on
palatal surface of upper incisors.
Average to high angle cases:
1. Appliance placement on upper arch only
proclination of upper incisors , this frees
lower incisors for placement of brackets.
2. placement of coloured adhesive on occlusal
surface of first molars , then progressively
remove it.

11.  Horizontal accuracy:
-affects mainly canine & premolar.
- checked by mirror.
- in lower canine , position it more mesially to
ensure contact with incisors.
- in rotated teeth , toward the rotated surface.
Error will lead to improper rotation
‣ Axial accuracy : the bracket wings parallel to
the long axis. Error will lead to improper tip
*hint:: to improve accuracy of angulation ,
bond with a DPT radiograrh .

12.  Vertical accuracy:
- better to use gauges and positioning charts
specially in these situations:
o Tooth length disrepancy.
o Fractured tooth.
o partially erupted tooth.
o Labially & lingually displaced roots.
o Gingival hyperplasia.

13.  General variations:
1.Extraction cases.
2.fractured incisal edge.
3.premolars.
4.molars.
 Local variations.

14. 1. Extraction cases: brackets should be 1mm
more gingival to increase torque expression
which if not correct leads to marginal
discrepancy btw 3 & 5.
2. Fractured/worn incisal edge/ cusp tip:
should be restored in operator’s mind prior
to bonding. ( the first incisor bracket placed
should be on the tooth with the most
natural shape & crown height.) then other
teeth according to that tooth.

15. 3. premolars: avoid placing the brackets too
occlusally specially in lower arch which can
leads to :
-infra-occlusion.
- incorrect torque.
- brackets being bitten off.

16. 4. molars:
- Its preferable to show more mesial cusp
than distal cusp particularly in premolar
extraction cases.
- its desirable for the tubes on second
molars to be 1-2 mm more occlusal than 1st
molars to prevent them from taking the
majority of occlusion forces. ( specially in
high angle cases to ensure that palatal
cusps don’t hang below & cause
interference.

17. 1. Class II div 1 with lateral incisors palatally
displaced.
2. Absent lateral incisor : space closure.
3. Class III : canine angulation.
4. Palatally displaced canine : labial movement.
5. Absent upper central incisor: space closure.
6. Class III: incisor inclination.
7. Second premolar extraction.
8. Risk of unwanted lower incisor proclination.
9. Class II molars after extraction of two maxillary
premolars.
10. Extraction of a lower incisor.

18.  Labial root torque can be achieved by:
- -Third order wire bend (e.g. with Rose
torquing plier)
-tooth torquing auxilliary
- invert lateral bracket , which also increase
pt’s comfort by gradual introduction of
torque.
 The change will be according to the
prescription::
*Andrew 6(3 to -3) * Roth 16 (8 to -8)
*MBT 20(10 to -10)

20.  One suggestion is to bond lateral incisor
bracket on the canine but:
- problem of bracket fit ( we can recontour
the canine to mimic lateral )
- greater crown-root angle in canine leads
to insufficient torque.
 A preferred option is to invert canine bracket
on the canine . * MBT & andrews (-7 to 7) *
Roth (-2 to 2) MBT identical tip also.

21. The effect of inverting canine brackets
in case with
absent lateral incisors and where the
canines are to replace the
absent teeth

22.  Contra-lateral canine brackets on the lower
canines encourage the crowns to tip distally.
 This will help in:
1. dentoalveolar compensation is facilitated.
2. anchorage requirements are reduced.
• Andrews : 5 tip becomes 10 difference
• MBT : 8 becomes a 16 difference.

23. Contra-lateral brackets placed upon
the lower canines. The crowns are
tipped distally.
(b) Clinical photograph with lower
canine brackets transposed to achieve
dental camouflage in a Class III
malocclusion

24.  One option is to invert lower contra-lateral
canine bracket onto the upper canine.
 MBT would provide no benefit as torque
values are similar in upper & lower canine.
 Roth provides a difference of 9 (-2 to -11)
 Andrews provides a difference of 4 (-7 to -
11).

25.  Moving the lateral incisor mesially.
 It is useful to bond the contra-lateral central
incisor bracket to tilt the tooth so that its
distal crown aspect becomes vertical .
 this permits to build up the distal surface
with an optimal emergence profile .
 This also avoids the problem of retention
from a mesio-gingival margin on the
restoration.

26. Contra-lateral central incisor bracket
placed on the
upper left lateral incisor. Note the
exaggerated tip, which brings
the mesial surfaces together and
allows build up of the distal emergence
profile

27. Clinical photograph with absent central
incisors. Upper
canine brackets are inverted to provide
additional palatal root
torque. The lateral incisor brackets are
transposed to achieve
improved root paralleling prior to
mesial movement and restorative build
up

28.  In camouflage treatment of class III the upper
incisors tend to be proclined .
 Subtelny & Catania advocated the use of
labial root torque and tying the archwire
forward to advance A point and boost
ant.post arch length.
 An option is to invert incisor brackets to
provide labial root torque.
 For central incisor :: *Andrews 14 change (7
to -7) * Roth 24 change ( 12 to -12) *MBT
34 change (17 to -17)

29.  To avoid inadequate root parallelism with
excessive apical seperation between the 1st
premolars & molars , we can:
1. Use of Roth molar tube.
2. Ensuring the molar band is well seated
mesially.
3. Banding second molars and keeping the
appliance in place for several weeks
following space closure.
4. Bonding premolar bracket at slight angle to
ensure apical correction.

30.  The use of lower incisor bracket of -6
torque ( lingual crown torque ) is
equivalent to introducing 5 torque in
the archwire.

31.  When the aim is to achieve a class II molar
interdigitation.
 The upper molar mesiobuccal cusp needs to
be tucked in between the lower 2nd premolar
and 1st molar . And distobuccal cusp needs to
be more buccal to avoid edge to edge
occlusion with lower molar.
 The tube prescription required is 0 M-D
angulation , 0 rotation, 14 buccal root torque.
 Other option is to use contra-lateral MBT
lower second molar tube on the first molar.

32.  It is helpful to place the lower incisor
brackets a little more gingivally to level the
incisal edges and canine tips.
 Also it is advisable to angulate the brackets
of the incisors each side of the extraction
space by a few degrees so that the apices are
closer together than usual.

33.  “Thicket , Taylor and Hodge “Choosing a pre-
adjusted orthodontic appliance prescription for
anterior teeth , “ journal of orthodontics Vol ,34
2007.
 David Birnie ,Nigel Harradine :Excellence in
orthodontics , 2012 lecture course , chapter 6 .
 Mc Laughlin RP .Bennet JC. Bracket placement
with the preadjusted appliance .J clin ortgod
1995 ,29(5).

34. Thank you