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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
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

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

Historical Perspective of Orthodontic Brackets


In this Chapter

History

Begg Appliance

Pierre Fauchard

Other Appliances

Modifications of bandeau appliance

Modification of Standard Edgewise Appliance

Development of edgewise appliance

Self ligating brackets

E Arch

Light wire Appliances

Pin and Tube Appliance

Lingual brackets

Ribbon Arch Appliance

Customized labial brackets

Edgewise Appliance
Orthodontic brackets are important part of fixed
appliances which are temporarily attached to
the teeth during the course of orthodontic
treatment. They are used to deliver forces from
the wires or other power modules to the teeth.
Before going into the details of orthodontic
brackets a historic preview on the evolution of
brackets is given.
History
The origin of orthodontic brackets can well be
coined with the origin of orthodontics and the
human desire to align crooked teeth. The first
written record1 to correct crowded or protruded
teeth is found 3000 years ago. Orthodontic
appliances to correct maligned teeth have been
found in Greek, Etruscan and Egyptian artifacts
2
.These ranges from crude metal wire loupes to
metal bands wrapped around individual teeth in
ancient Egyptian mummies3. Pliny the Elder

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


elongated teeth4.
Pierre Fauchard
Pierre Fauchard (1678 1761) a French dentist
was the first to make a scientific attempt to align
irregular teeth by an appliance named Bandeau
(Figure 1.1 & 1.2).This appliance was made of
precious metal and it was shaped like a horse
shoe to align teeth by arch expansion. Fauchard
also used to reposition irregular teeth with his
Pelican forceps and then ligate them with
neighboring teeth until healing took place.
Fauchard published his work in 1728 in his
landmark book entitled The Surgeon Dentist: A
Treatise on the Teeth.

Historical perspective of Orthodontic Brackets

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.

Figure 1.1

Pierre Fauchard

In 1803, Joseph Fox invented a modified


version of bandeau appliance that consisted of
silver or gold rim. Silk thread was used as mode
of attachment and force transfer between the
rim and teeth. These silk threads were adjusted
after every three weeks (Figure 1.3a). Blocks of
ivory were used to disocclude the occlusion and
to prevent interference with tooth movement. J.
M. A. Schange (1841) a French dentist wrote the
first book exclusively on orthodontics. He
modified bandeau appliance and took
anchorage by skeletal cribs attached to molars
(Figure 1.3 b). He also invented an appliance to
move malposed teeth within the arch (Figure
1.3 c).Harris in 1850 attached metal caps to
molar and took anchorage from palate in his
expansion appliance (Figure 1.3d)
Development of edgewise appliance
Norman W. Kingsley (1825-1896) and Calvin
S. Case (1847-1923) advocated extraction for
orthodontic purpose. Though Norman W.
Kingsley later abandoned his extraction
philosophy. This extraction philosophy later
influenced the basic design of orthodontics
braces.

Figure 1.2 Bandeau Appliance

Modifications of bandeau appliance


Fauchard's bandeau appliance was further
refined by another fellow French dentist
Etienne Bourdet (1722-1789) who was a dentist
to the King of France in his time. Etienne
Bourdet was also the pioneer of lingual
orthodontics by expanding the arch by metal
framework placed on the lingual side.
Christophe Franois Delabarre (1787-1862)

Edward Hartley Angle5 (1855-1930) was the


most dominant and influential figure in
orthodontics and is regarded as the Father of
Modern Orthodontics. (Figure 1.4). Because
of Edward Angle, orthodontics was recognized
as a distant and separate science6 from general
dentistry. In his initial days of orthodontic
practice Angle advocated extraction in
orthodontics .But latter on the basis of Wolff's
law that bone in a healthy person will adapt to
applied load Angle abandoned extraction
treatment. Also another reason to abandon
extraction treatment was failure to get
satisfactory result after extracting 1st maxillary

CHAPTER

Material Perspective of Orthodontic Brackets


In this Chapter

Introduction
Manufacturing Techniques

Plastic Brackets
Plastic Polyoxymethylene brackets

Casting

Polyurethane brackets

Milling

Composite plastic brackets

Sintering
Metal injection molding (MIM)

Ceramics Brackets
Aluminum oxide or Alumina (Al2O3) brackets

Ceramic injection molding (CIM)

Monocrystalline brackets

Plastic injection molding (PIM)

Polycrystalline brackets

Brazing

Zirconia brackets

Cold working

Calcium phosphate ceramic brackets

Metal Brackets
Stainless steel brackets
Cobalt chromium brackets
Titanium brackets
Precious metal brackets

Introduction
Contemporary orthodontic brackets are
modification of a standard edgewise brackets
developed by Edward H Angle. At the time of
edgewise brackets invention stainless steel
alloy although invented was in the phase of
evolution and orthodontic brackets soldered to
bands were largely made of 14 karat or 18 karat
gold. Rudolf Schwarz 1 was the first to use

13

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 :

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.

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 used29 presently for orthodontic brackets
manufacturing .In cobalt based wear resistant
alloys CoCr brackets are made from ASTM F75 CoCr where ASTM stands for American
Society for Testing and Materials. The amount
of nickel in this alloy is kept low 29and is up to
0.5 %. Composition of cobalt based wear
resistant alloys is given in table 2.3. A cobalt
chromium bracket is shown in figure 2.19.

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

Properties of Cobalt Chromium


Brackets
Friction Resistance
In terms of friction resistance cobalt chromium
brackets show comparable30, 31 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
titanium brackets30 with both stainless steel and
beta titanium wires.
Corrosion Resistance
Because of increase chromium contents there is
less chance of corrosion32 of cobalt chromium
brackets.

Figure 2.19 Nu- Edge Mini Cobalt Chromium Brackets


by TP orthodontics with 0.5 % nickel.

27

Material perspective of Orthodontic Brackets

Selection of Stainless steel brackets

Material perspective of Orthodontic Brackets

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.
Titanium Brackets
Titanium metal has excellent biocompatibility
and increased corrosion resistance18, 33, 34 so it has
wide ranging surgical application from artificial
heart valves and hip joints to dental implants.
In orthodontics to overcome the release of
nickel from stainless steel brackets which may
cause nickel allergy in some patients, titanium
brackets have been introduced35, 36 as nickel free
alternatives to stainless steel in mid 1990s.
Types of Titanium
From material science perspective titanium has
the following three types:

4 CP titanium, which offers highest strength and


moderate formability. Composition of different
grades of CP titanium is given in table 2.5.
Contemporary titanium brackets21, 37 are either
manufactured from alpha titanium grade 2 and 4
or alpha-beta titanium (Ti-6Al-4V).Grade 2 CP
titanium is usually used to make base
component of brackets due to its decreased
strength while the wing component is made
from much harder titanium alloy, the alpha -beta
titanium Ti-6Al -4V.Both these components are
laser welded to make a single unit of bracket. As
explained before for stainless brackets
combination of harder slot/wings part and softer
base part has clinical importance. The softer
base part will allow easy mechanical debonding
while harder slot/wings part will allow
expression of torque.
Due to release of vanadium37from titanium alloy
Ti-6Al-4V which may have biological
hazardous effects some manufacturer make
single unit milled or metal injection molded
bracket from grade 4 CP titanium.

Characteristics of Titanium brackets


1. Titanium
Corrosion Resistance
2. titanium
3. & Titanium
Alpha titanium is commercially pure (CP)
unalloyed titanium while the other two types are
titanium alloys. titanium include Ti-15V-3Cr3Sn-3Al alloy while - titanium included Ti6Al-4V alloy. Alloyed titanium has greater
strength than unalloyed titanium. Chemical
composition of various types of titanium is
given in table 2.4.
Commercially pure (CP) titanium is further
classified into four grades depending upon
degree of impurity, primary oxygen within the
unalloyed titanium. Grade 1CP titanium has the
lowest strength but highest purity, corrosion
resistance and formability as compared to grade

Titanium and titanium alloy brackets have


greater corrosion resistance than stainless steel
brackets. This is due to the presence of thin
passive protective layer of titanium dioxide
over the titanium. This layer of titanium dioxide
is more stable23 than its counterpart layer of
chromium oxide on stainless steel. The
composition of titanium dioxide layer which is
also called rutile is given in table 2.6.
Brackets in which two parts are joined together
by welding have greater chances of galvanic
corrosion than one piece milled or MIM
brackets. A titanium bracket is shown in figure
2.20.

28

Material perspective of Orthodontic Brackets

CHAPTER
than conventional ceramic brackets and these
brackets don't cause enamel damage.
Selection of ceramic brackets
Ceramic brackets are usually selected for
patients who have aesthetic concerns. Due to
iatrogenic damages associated with ceramic
brackets they should only be selected when
clinicians have proper knowledge of
mechanics and proper instrumentation for
debonding is available.
Monocrystalline brackets give better
aesthetic than polycrystalline brackets but are
more expensive and fracture easily and more
with time. Zirconia brackets are rarely used in
contemporary orthodontics. Calcium
phosphate ceramics is manufactured by only
one company and not much is known about
these brackets so selection of these brackets is
a personal preference.

Vivo: Aging and Related Phenomena. New York, NY: Quintessence;


2003:141156.
8. Brockhurst PJ, Pham HL. Orthodontic silver brazing alloys.
AustOrthod J. 1989;11:9699.
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:
229231.
11. Grimsdottir MR, Hensten-Pettersen A, Kullmann A. Cytotoxic effect
of orthodontic appliances. Eur J Orthod. 1992;14:4753.
12. Oh KT, Choo SU, Kim KM, Kim KN. A stainless steel bracket for
orthodontic application. Eur J Orthod. 2005 Jun;27(3):237-44.
13. Feldner JC, Sarkar NK, Sheridan JJ, Lancaster DM. In vitro torquedeformation 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.)

References

18. Eliades T, Athanasiou AE. In vivo aging of orthodontic alloys:


implications for corrosion potential, nickel release, and
biocompatibility. Angle Orthod. 2002 Jun;72(3):222-37.

1. Hotz RP. The changing pattern of European orthodontics. Br J Orthod


1973; 1:4-8.

19. Schiff N, Dalard F, Lissac M, Morgon L, Grosgogeat B. Corrosion


resistance of three orthodontic brackets: a comparative study of three
fluoride mouthwashes. Eur J Orthod. 2005 Dec;27(6):541-9.

2. Matasa C. Characterization of used orthodontic brackets. In: Eliades


G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials in Vivo:
Aging and Related Phenomena. New York, NY: Quintessence;
2003:141156.
3. Zinelis S, Annousaki O, Makou M, Eliades T. Metallurgical
characterization of orthodontic brackets produced by Metal Injection
Molding (MIM). Angle Orthod. 2005 Nov;75(6):1024-31.
4. Floria G, Franchi L. Metal injection molding in orthodontics.Virtual
J Orthod. 1997:2.1.
5. Coley-Smith A, Rock WP. Distortion of metallic orthodontic brackets
after clinical use and debond by two methods. Br J Orthod. 1999
Jun;26(2):135-9.
6. Zinelis S, Annousaki O, Makou M, Eliades T. Elemental composition
of brazing alloys in metallic orthodontic brackets.Angle Orthod.
2004;74:394399.
7. Matassa C. Characterization of used orthodontic brackets. In:
Eliades G, Eliades T, Brantley WA, Watts DC, eds. Dental Materials In

20. Oh KT, Choo SU, Kim KM, Kim KN. A stainless steel bracket for
orthodontic application. Eur J Orthod. 2005 Jun;27(3):237-44.
21. Eliades T, Zinelis S, Eliades G, Athanasiou T. Characterization of
as-received, retrieved and recycled stainless steel brackets. J Orofac
Orthop. 2003;64:8087.
22. Hunt NP, Cunningham SJ, Golden CG, Sherif M. An investigation
into the effects of polishing on surface hardness and corrosion of
orthodontic archwires. Angle Orthod. 1999;69: 433440.
23. Brantley WA. Orthodontic wires. In: Brantley W, Eliades T, eds.
Orthodontic Materials: Scientific and Clinical Aspects. Stuttgart,
Germany: Thieme; 2001:95.
24. Eliades, T., Eliades, G., Brantley, W.A. (2001). Orthodontic
brackets, in: Brantley, W. A., Eliades, T. (Eds.), Orthodontic Materials:
scientific and clinical aspects Thieme, Stuttgart, 146-147.
25. Platt JA, Guzman A, Zuccari A, Thornburg DW, Rhodes BF, Oshida
Y, Moore BK. Corrosion behavior of 2205 duplex stainless steel. Am J
Orthod Dentofacial Orthop. 1997 Jul;112(1):69-79.)
26. Eliades T. Orthodontic materials research and applications: part 2.

38

CHAPTER

Selection of Bracket Base


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

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

Titanium Brackets

Bracket identification marks

Cobalt Chromium Brackets

Torque in the Base

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.

41

Precious metal Brackets

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

Selection of Bracket Base

CHAPTER
are not provided from the manufacturer some
basic informations are available.
1) Stainless steel Brackets
Most orthodontic brackets used in
contemporary orthodontics are made of
stainless steel which mostly uses mechanical
retention because stainless steel doesn't form
any chemical union with adhesives. Stainless
steel bracket base is either integral part of the
bracket or is made separately and then joined
to the main body of the bracket by brazing or
welding (Figure 3.1).Different types of
stainless steel bracket bases are given in the
following text.
1. Perforated bases
Brackets with perforated bases are one of
the oldest bracket designs for mechanical
retention1 (Figure 3.2). The original metal
pad consists of one row of peripheral
perforation. The basic idea was to allow
greater penetration and free flow of
adhesive cement through the bracket base
to increase the bond strength. But
unfortunately excessive adhesive coming
out of the holes of bracket base was
potential plaque retention area which get
discolored with time so raised esthetic
concerns by the patients and don't provide
superior retention as compared to other
designs2,3,4,5,6. Because of these
disadvantages perforated bracket bases
went into disuse.
2. Mesh type bases
Mesh type bases have replaced perforated
bases and are most popular type used in
contemporary orthodontics. Following
different terms are used for mesh based
bases in literature and by manufacturer
owing to slight variation in mesh design.

a) Foil mesh base


b) Gauze or woven mesh base
c) Mini mesh base
d) Micro mesh base
e) Optimesh base
f) Ormesh base
g) Laminated mesh base
h) Single mesh base
I) Double mesh base
j) Supermesh base
Description of some important mesh
designs is as follows.
a) Foil mesh base
In orthodontic literature the term foil
mesh base is used interchangeably with
gauze or woven mesh base. But there are
slight differences in the manufacturing
design between foil mesh and woven
mesh base (Figure 3.3) .Foil mesh bases
are more esthetic and hygienic than
perforated bases because of their smooth
covered surface 2, 3, 7, 8 . Foil and woven
mesh bases provide superior retention
than perforated bases and many other
bracket base designs used in
contemporary orthodontics 4, 7, 9. Foil mesh
bases can be simple or microetched,
photoetched or plasma coated by the
manufacturer. The foil mesh is either
brazed or welded on to the bracket base.
The spot welding of foil mesh to bracket
base results in decreased base surface
areas and so bond strength 2, 4, 10 therefore
spot welding have been taken over by
silver based laser welding 11.
Foil mesh bases can be single mesh or
double mesh.

42

Selection of Bracket Base

CHAPTER

lower bond strength than high filled


adhesives.
Another alternative is to use glass ionomer or
resin modified glass ionomer41 cements
(RMGIC) with ceramic brackets as glass
ionomer cements have shown to have
decreased 42,43 but clinically acceptable bond
strength32, 44, 46 than composite resins . Though
bond failure of glass ionomer cement is
present at enamel adhesive interference but
no enamel damage is reported 44, 45 with this
adhesive cement because RMGIC has lower
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.
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.
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 12.5mm2 to 28.5 mm2.
Greater the retentive bracket base area greater
would be the bond strength and vice versa
(Figure 3.27). But there is practical limitations

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.

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 MacColl49
recommended that bracket base surface area
should be around 6.82 mm2. 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:
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
strength50 is around 5.9 to 7.8 Mpa but bond
strength shouldn't exceed 51 than 13.5Mpa to
avoid enamel damage.

56

CHAPTER

Selection of Bracket Slot


In this Chapter

Introduction

Bidemensional mechanics

Type of bends for 3 dimensional tooth


movements

Morphology of the brackets

Dimensions of Edgewise slot


Accessary slots
Tip edge brackets

Gingival offset brackets


Slot modifications to reduce friction
Ligation: The fourth wall of Bracket slot
Tie Wings of the brackets

Advantages of 0.018 slot


Advantages of 0.022 slot

Introduction
Slot is part of the bracket in which the wire is
engaged to express the builtin prescription of
the bracket. The slot of the bracket has seen
much evolution with time. It started from
occlusal opening slot in Angle ribbon arch
appliance to gingival opening slot in Begg
appliance and front opening slot in Angle
edgewise system. In contemporary orthodontics
edgewise slot is universally accepted .Vertical
slots are still used in some bracket series but
usually as an accessary slot.
When bracket slot was first introduced they
were simple openings in which a bended wire
incorporating all the necessary tooth
movements was inserted. The brackets having
such passive slots were called standard
brackets. With time 1st, 2nd and 3rd order bends

61

were incorporated in brackets to produce


respective tooth movements 1. Before going into
the details of slot a brief description of these
bends and associated movements are given.
Type of bends for 3 dimensional tooth
movements
First order bends (In or out bends)
First order bends are given to accomplish first
order tooth movements which are in a
labiolingual or buccopalatal direction. 1st order
bends can be made in horizontal direction in the
wires such as the step bends, or are
accommodated in the brackets (Figure 4.1). As
different teeth in the arch have different width
these bends made in the wire or built into the
bracket are used to accommodate different tooth
width. Vertical step bends that don't change the

Selection of Bracket Slot

CHAPTER

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.

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.

Figure 4.2
Maxillary lateral incisor brackets from two
different manufacturers having same builtin prescription.
The height or prominence of these brackets is different.

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
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

CHAPTER

Selection of Auxiliary and convenience features


In this Chapter

Auxiliary features
Power arms
Accessary slots
Convenience features
Vertical Mid Scribe line
Shape of brackets
Bracket identification

Many auxiliary and convenience features are


added to the brackets and tubes to make
treatment mechanics easier and convenient.

Auxiliary features
Power arms
Power arms are added to the brackets on its
gingival side to control root position during
translation of the teeth. The reason for making
power arms on gingival side is to bring the force
application closer to the center of resistance of
the teeth. Andrew1 proposed that for effective
control of root position during translation, the
mesiodistal length of bracket plus height of
power arm should be equal to distance from the
slot point to tooth center of resistance (Figure
5.1). As root of canine is longer than other teeth
so power arm of canine tooth would also be

77

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

Selection of Bracket Prescription


In this Chapter

Introduction
Andrew Prescription
Key I: Interarch Relationship
Key II: Crown Angulation or
Mesiodistal Crown tip

Different Bracket prescriptions


Roth Prescription
Limitations of Roth Prescription
MBT Prescription
Alteration of prescription

Key III: Crown inclination or Torque


Key IV: Absence of Rotations
Key V: Tight Contact points
Key VI: Flat Occlusal plane or Curve
of Spee
Limitations of Andrew prescription

Introduction
Angle introduced edgewise brackets to have a
better control on three dimensional positions of
the teeth. But the problem in these brackets was
that complex wire bending was required to
control the tooth position. Andrew 1,2 modified
the standard edgewise brackets developed by
Angle by introducing tip, torque and in& outs in
his preadjusted edgewise brackets .The amount
of tip torque and in & outs built within
preadjusted brackets were called prescription of
the brackets. After Andrew a lot of orthodontists
introduced their versions of bracket prescription
sometimes based on studies and many times
based on clinical experience. Each clinician

83

who advocated a specific prescription also


advocated specific mechanics during the course
of treatment for expression of the prescription.
In medicine to treat a disease properly, the right
diagnosis should be made. That helps the
physician to advise the right prescription of
drug .Same is true in orthodontics. After making
a right diagnosis and treatment planning of a
malocclusion the right prescription should be
used. Using the right prescription, simplify the
treatment mechanics which will save
considerable chairside time. In most cases there
would be minimal or no need of wire bending
during the course of orthodontic treatment.

Selection of Bracket Prescription

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.
Andrew Prescription
Lawrence F. Andrew1 introduced the first
preadjusted brackets where all the bending's
needed in archwire in standard edgewise
bracket system were built within the brackets. It
was proposed that this appliance does not
require wire bending during treatment hence the
name Straight wire appliance (SWA) was given
to it.
Andrew after a study on 120 non-orthodontic
ideal occlusion dental casts concluded that in
order to attain ideal occlusion some
characteristics must be present within the
occlusion. These characteristics were divided
into six keys. Based on these 6 keys Andrew
developed his prescription of brackets, so that
using this bracket prescription no wire bending
would be required during treatment and at the
end of treatment, all the six keys to normal
occlusion would be attained.
Andrew apart from studying these nonorthodontic ideal occlusion dental casts also
studied 1150 orthodontic treated cases so that
his prescription could also address some of the
problems not found in ideal occlusion e.g.
Extraction cases where molar relation may
deviate from class I relationship.
Most of the modern preadjusted brackets are
minor modification of Andrew straight wire
appliance. To give a better understanding of
prescription so that clinician can make an easy
selection of brackets a complete description of
Andrew six keys to normal occlusion and how
prescription components evolve from each key
is given. Details on how a prescription in
bracket is transferred to a tooth are also given

with each key so that the readers can have a clear


knowledge of effects and limitations of a
prescription.
Key I: Interarch Relationship
Key I as originally proposed by Andrew 1 was
molar relationship. But in 1989 Andrew2
changed the key from molar relationship to
interarch relationship. Interarch relationship is
broader and more definite description of
occlusal relationship than relying on molar
relations only. Interarch relationship as key 1 is
considered in this text because it will clear the
reader's mind about the basis and need of
prescription.
Key I have seven parts 2 which are given below:
Part 1
The mesiobuccal cusp of the maxillary first
permanent molar fits in the groove between the
mesial and middle buccal cusps of the
mandibular first permanent molar.
Part 2
The distal marginal ridge of maxillary 1st molar
occludes with mesial marginal ridge of the
mandibular 2nd molar.
Previously1 this relation was. "The distal
surface of the distobuccal cusp of maxillary 1st
molar made contact and occluded with the
mesial surface of the mesiobuccal cusp of the
mandibular second molar." The closer these
two surfaces of maxillary 1st and mandibular
2nd molar contact and occlude , the better
would be the opportunity for normal
occlusion.
Part 3
The mesiolingual cusp of the maxillary 1st
permanent molar occludes in the central fossa of
mandibular 1st permanent molar.

84

The buccal cusp of the maxillary premolars


have cusp embrasure relationship with
mandibular premolars. The maxillary 2nd
premolar buccal cusp lies between embrasure of
mandibular 1st molar and mandibular 2nd
premolar. Buccal cusp of maxillary 1st premolar
lies in the embrasure between mandibular 1st
and 2nd premolars.
Clinical Notes
To check if a case has attained Key I,
always judge from buccal aspect clinically
and both from buccal and lingual aspects on
the dental cast.
Part 5
The lingual cusp of the maxillary premolars has
a cusp fossa relationship with mandibular
premolars.
Part 6
The maxillary canine tip lies slight mesial to the
embrasure between mandibular canine and 1st
premolar.
Part 7
The maxillary incisors overlap the mandibular
incisor with their dental midlines coinciding.
A description of key I is given in figure 6.1.

A
Figure 6.1

85

Incorporating key I into bracket


prescription
Key I is interrelated with next 5 keys to normal
occlusion. Key I will only be achieved when the
rest of the keys have been achieved too.
To attain key I, a preadjusted bracket should
have built in 1st, 2nd and 3rd order bends and
brackets should be optimally placed on the
tooth. Only description of 1st order bends and
how and why they are included in the
prescription would be given here. The rest
would be discussed in their respective keys.
To incorporate the right amount of 1st order
bends with in his prescription Andrew 2
measured the facial prominence of each tooth
within the arch of an ideal occlusion
case .This was done by measuring the distance
from the embrasure line to most prominent
facial point of each tooth, where embrasure
line is imaginary line at crown mid transverse
plane that connects the facial portion of
contact areas of a single crown or all the
crowns in an arch when the crowns are
optimally placed. Figure 6.2 and table 6.1.
From the figure 6.2 and table 6.1 it is clear that in
maxillary arch lateral incisors have least facial
prominence while in mandibular arch both
central and lateral incisors have least facial
prominence. These values were built within the
base or stem of the brackets so that at the end of
leveling and alignment all the brackets slots

B
An ideal occlusion case meeting all the criteria of key I . A .Buccal aspects . B. Lingual aspects

Selection of Bracket Prescription

Part 4

Selection of Bracket Prescription

CHAPTER

have same level of prominence while all the


teeth have the prominence value found in table
6.1.
How it works?
To build the right amount of prominence within
the brackets, Andrew incooperated a simple rule
that the distance between most prominent facial
point of the crown and the embrasure line is
inversely proportional to the distance between
slot point and most prominent facial point of
crown in mid transverse plane.(Figure 6.3A) .
This means that if a tooth has less facial
prominence of crown it would have increased
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.

B
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.

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
found to be 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


Canine

1stpremolar

2ndpremolar

1st Molar

2nd Molar

Maxillary Arch

Central Lateral
incisors incisors
2.1mm 1.65mm

2.5mm

2.4mm

2.4mm

2.9mm

2.9mm

Mandibular arch

1.2mm

1.9mm

2.35mm

2.35mm

2.5mm

2.5mm

Teeth

1.2mm

86

Selection of Bracket Prescription

CHAPTER

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.

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

increased at the end of treatment.


Clinical implication of Key VI
Nothing is built within bracket prescription to
accommodate key VI because it is more related
with position of the brackets on the teeth.
Accomplishing this key is very important for a
good occlusal outcome. Andrew found that
nonorthodontic dentition has flat to slight curve
of spee and preposition of flat curve of spee was
given to accommodate natural tendency of
curve of spee to increase with age due to growth
of lower jaw and its growth rotation. Banding or

bonding the second molars also help in leveling


of curve of spee .Usually leveling 1mm of curve
of spee 37 require less than 1mm of space. A
description of curve of spee is given in the
figure 6.44.
Limitations of Andrew prescription
Large inventory
In Andrew system to deal with different types of
arch discrepancies there are 12 maxillary and 11
mandibular sets, which are combination of five
different types of brackets .These are

118

T1 Minimum Translation Brackets


T2 Medium Translation Brackets
T3 Maximum Translation Brackets
T4 Maxillary Molar tubes or bands for Class
II&III
Andrew gave such a big inventory to make the
treatment more individualized. But
unfortunately this became one of the biggest
limitations of his prescription. Making so many
different types of brackets means that there is
need for more machinery, more space, more
work force and so more finances needed for the
manufacturer. Also when there are so many
different types of brackets, more time and
education is needed for the orthodontist to get a
better understanding for making the right choice
in each case. So when there is no Magic formula
available, orthodontics will remain only for
professional orthodontists. This means loss of
valuable clientage for the manufacturers.
Unfortunately the problem in orthodontics is
that if the orthodontist is customizing treatment

by bracket prescription or by wire bending he is


wasting his time but if the manufacturer is
customizing brackets it's an innovation and you
have to pay for that innovation.
For the orthodontist keeping a large inventory at
orthodontic office means there is need for more
financial resources and more office space. This
is obviously against the core rules of good office
financial management. So unfortunately the
very benefit of Andrew prescription to provide
individualized treatment to some extent became
the most limiting factor of its wide acceptance.
Tip and Torque
Both tip and torque values placed in Andrew
prescription are slight different from Andrew
original findings of normal occlusion 2.
Tip in Andrew Straight wire appliance and
actual tip from his study are given in table 6.12.
There is overall increased in tip in SWA as
compared to Andrew original findings. For
change in tip values it is generally presumed that
Andrew made the changes to accommodate
wagon wheel effects. There are some questions
in this regard that for the time being have no

Table 6.12

answers. Do we need to accommodate wagon


wheel effect in class I incisor torque as it is
natural position of the incisors within the arch?
If wagon wheel effects occur due to anatomy of
area and our treatment mechanics, why not the
tip is decreased in the prescription in case of
class II incisor torque and increased in case of
class III incisor torque?

119

Torque values were also changed by Andrew to


some extent than original norms (table
6.13).Overall there is decrease in torque values
in SWA as compared to original findings. After
going through Andrew work my understanding
is that Andrew changed the upper incisor torque
values to incorporate finding of his unpublished
100 cases cephalometric study. For example in

Selection of Bracket Prescription

S Standard Brackets

Selection of Bracket Prescription

CHAPTER

Table 6.13

original Andrew's norms the maxillary central


incisor class I torque was 6.11 while the lateral
incisor torque was 4.42.In cephalometric study
Andrew found that there is always 4 difference
between maxillary central and lateral incisor
torque. So I presume that he changed the torque
of central to 7 and lateral to 3 to make that
study count. Other values were changed either
to incorporate clinical experience or to round off
values for ease of standardization.

Apart from this, Andrew also didn't take in


consideration various factors that affect the
expression of tip and torque especially the play
of the wire. This is because Andrew advocated
full dimension wires at the end of treatment for
expression of entire builtin tip and torque.
Because of their increased stiffness use of full
dimension wires have been abandoned and so
the problem started with expression of the
prescription.
Counter-rotation
Andrew incorporation of counter rotation into
the slot was also not appreciated by many.
Though effective during space closure but if the
orthodontist remain on a heavier wire for long
time using effective ligation of wire to
consolidate tooth position or torque correction
after space closure the teeth having counter
rotation brackets will become rotated due to
expression of prescription .
So Andrew prescription presents a dilemma for
clinician in extraction cases. Moving to heavier

wire for better tip and torque expression as


Andrew didn't accommodated wire play in his
prescription but such wire will cause counter
rotation expression. Many clinicians who
favors counter rotation in brackets for
extraction cases and also have included counter
rotation in their own prescription advocate that
as relapse is inevitable so the rotation is part of
over correction and it will eventually be
relapsed during the settling phase. But the
practical problem a young orthodontist face
today is that he has to display his finished case
in exam and complete the settling phase with
elastics or wire bending than going on natural
settling with retainers. It is difficult to settle
teeth into occlusion when they are rotated.
Correction of rotation will leave space in the
arch and there are many different retainers of
modern day such as fix retainers and vacuum
formed retainers that don't allow settling to the
extent as Hawley retainers do.
So orthodontists are left with two choices when
using counter rotation brackets at the end of
treatment. Replace bracket with standard
brackets or resort to wire bending.
Limitations in Mechanics
As expression of bracket prescription depend
upon what mechanics one uses, many clinicians
who later made their own prescription pointed
out some mechanics flaws present in Andrew
philosophy for case treatment. These were
1) Anchorage loss

120

2) Leveling Curve of Spee


Many clinicians also didn't agree with
Andrew philosophy of leveling curve of spee
with compensatory curves in wires in
maxillary arch and reverse curves in wire in
mandibular arch.
3) Roller coaster effects
In early years of SWA class II elastics were
used for sliding mechanics. In order to
overcome friction heavy forces were used.
Increased anterior tip, vertical component of
elastics and heavy forces resulted in
deepening of anterior bite and opening of
lateral bite. This effect was called Roller
Coaster Effect (Figure 6.45).

of variation32 between long axis of clinical


crown and long axis of the tooth. Placing the
bracket just by keeping in mind the long axis
of clinical crown will result in poor root
parallelism in many cases. Also due to
increase tip built into Andrew prescription
there are chance of root approximation of
teeth especially between maxillary canines
and premolars.
5) Bracket Height
Andrew advocated bracket placement at mid
of long axis or facial axis of clinical crown
also called LA point(long axis point) or FA
point(facial axis point). Judging the FA point
or LA point on a tooth was a matter of clinical
experience. Some clinicians3, 38 didn't agree
with validity of placing bracket at the FA
point to get an ideal occlusion while others39, 40
advocated that there are greater chances of
error in placing bracket on FA point and gave
fixed distance from incisor edge and
suggested using special gauges for bracket
placement. Effects of change in height on
bracket prescription have been discussed
before.
Because of these limitations different types of
bracket prescription were put forward with
time. Whether these new bracket prescriptions
solved any practical limitation of Andrew
prescription is still debatable but there is a
general consensus that they solved the problem
of manufacturers and general dentists in the
form of A Single Fairytale Bracket Set for All
Types of Malocclusion.
Different Bracket prescriptions

Figure 6.45
Roller coaster effects and anterior deep bite
and lateral open bite.

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

121

With time so many clinicians put forward their


own prescriptions of brackets .For effective use
of these prescriptions many of them also
advocated their own treatment mechanics and
bracket position on teeth. Even some clinician
went to the extent to recommend certain
commercial brands of wires for effective

Selection of Bracket Prescription

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.

Mandibular
Arch

Mandibular arch values of different prescriptions

Central
incisor

Lateral
incisor

Canine

1 st
Premolar

Torque Tip

Torque Tip

Torque Tip

Torque

2 nd
Premolar
Tip

Torque

1 st Molar

Tip

2 nd M olar

Torque Tip

Offset

Torque Tip offset

-5

+2

+5

+6

+6

10

Begg

Burstone

11

+6

17

22

27

27

+2

Damon
(standard
torque)

-3

-3

+4

+7

+5

-12

+4

+4

-28

+2

-10

Hasund

+5

+5

10

+2

15

+2

-22

+4

25

+2

Hilgers

+7

+6

11

17

25

25

Ricketts
IV.
Dimension
Ricketts

+7

+5

-7 ex
-14 nex

22

12

27

16

+7

+5

Standard
Edgewise

Tweed

0/6

0/6

Alexander

-7ex
0 nex

-17

Standard

diminution of force.
III. Leveling of curve of spee to some extent by
placing anterior brackets more incisal.
IV. More torque in anterior brackets to
accommodate torque loss by wire play.
V. Super torque brackets for rapid correction of
torque in class II div2 cases.
VI. Roth proposed a new archform called TruArch to be used with his prescription. Roth
advocated selection of archwire is important
as it effects the rotational position of teeth.
Wider the archform more positive torque
would be expressed and vice versa. Roth
archform was most prominent and wide at
mesiobuccal cusp of the first molars.
VII. Different translation philosophy.
According to Roth tipping of the teeth to some
extent is accepted on round wires.

123

VIII. Many auxiliary features were added to

brackets such as double and triple tubes,


addition of hooks for ease of mechanics.
How Roth Made this Prescription?
Dr. Andrew in one of his articles42 commented
on origin of Roth prescription. According to
Andrew, Dr. Roth found that a high percentage
of his cases can be treated by using Andrews'
class III incisor torque brackets for maxillary
arch and class I incisor torque brackets for
mandibular arch. For buccal segment Roth used
Series 1-C and Series II-Classic. Where series
1-C was given in all 1st premolar extraction
cases where both maxillary and mandibular
canines are given maximum translation series
brackets and both arches 2nd premolars are given
minimum translation series brackets while
molars are given standard SWA. Series IIClassic brackets were used in case of extraction
of maxillary 1st and mandibular 2nd premolars
because of class II molar relationship. In this
series maxillary canines and lower posterior

Selection of Bracket Prescription

Table 6.15

Selection of Bracket Prescription

CHAPTER
Table 6.16.
Teeth

Roth Prescription

Central
incisors

Lateral
incisors

1st & 2nd Premolar

Canine

Torque Tip Torque Tip Torque Tip

Maxillary
Arch

+12

Mandibul
ar arch

-1

+5

+8

+9

-2

+13

1st &2nd Molar

Rotatio Torque Tip Rotation Tip Torq Rotation


n

ue

2MR

-7

2 MR

-14 14DR/0
Class II

+2

-1

+2

-11

+7

2 DR

-17
P1&

-1

4DR

-1

-30

4DR

-22
P2

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

Roth prescription is given in table 6.16.


These comments by Andrew about Roth
prescription were made in 1976 and in the same
year Roth43 wrote an article about his 5 year
practice changing experience with Andrew
prescription. Unfortunately he didn't reveal
anything about his specific selection of brackets
from Andrew's work. It was in 1987, that Roth3
published his prescription and given
justification for it. That prescription is far
different from Andrew's comments. The only
comment true is about maxillary and
mandibular incisor tip and torque. A personal
review of literature by this author couldn't find a
prescription by name of Roth that matches
Andrew's comments. The first published Roth
prescription is given in table 6.16.

An evaluation of origin of this prescription is


given.
Maxillary Arch.

Canines
The maxillary canine tip is taken from
minimum translation series brackets made for
distal translation. Canine torque was Roth
personal calculation of torque to accommodate
wire play. Canine counter rotation feature was
also taken from Andrew distal translation group
in minimum translation series brackets.
Premolars
Both 1st and 2nd premolar tip was taken from
minimum translation series brackets requiring
mesial translation. Premolar torque was taken
from Andrew standard SWA. Counter rotation
feature was taken from minimum translation
series brackets for distal translation.
Molars
Both 1st and 2nd maxillary tip was selected from
Andrew Class II molar tip. Torque of molars
was selected from Andrew medium translation
series brackets. Counter rotation values for
molars were taken from medium translation
series for mesial translation.

124

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 2nd premolar extraction
cases where molar need mesial translation and
1st premolar need distal traction.

Controversy

The molar tip is meant for class II relationship


while offset is meant for class I molar
relationship.
Mandibular Arch
Canines
Canine tip is taken from minimum translation
series brackets for mesial translation while
torque is taken from Andrew standard SWA.
Counter rotation feature for canine is taken
from minimum translation series for mesial
translation.
Premolars
Premolars tip correlate with Andrew medium
translation series brackets. Torque values
remain similar to standard SWA while counter
rotation feature values are from medium
translation series for mesial translation.
Molars
Molars have tip of medium translation series
for mesial translation. 1st mandibular molar
torque remain same as that of standard SWA
while 2nd molar torque was made equal to 1st
molar. Counter rotation feature were also taken
from medium translation series brackets for

125

In mandibular arch canine is given minimum


translation series counter rotation feature and
tip values while molars and premolars have
medium translation series values. Second
molar torque was made equal to 1st molar.
Giving less torque on second molar increase
their chances of coming in cross bite as it's a
common finding that 2nd molars are usually
present slightly buccally as compared to 1st
molar in finished cases using Roth prescription.
Roth Justification for his prescription
Roth3 while giving his prescription gave some
justification for the specific selection.
Maxillary Arch
Roth3 justified his prescription by explaining
that 5 extra torque was added to maxillary
incisors keeping is line with his treatment
philosophy of overcorrection and
accommodating torque loss by wire play. So
without moving to full dimension wires the
clinician can attain natural inclination of
incisors.
For canines, Roth used -2 torque which was 5 less than Andrew prescription. This was
done to avoid reactionary effect of building
more positive torque into the incisors brackets.
This is explained in the figure 6.46. The final
torque of canine would be -7 due to
reactionary forces from the wire and because of
wire play. If no wire play is present the final
torque of the canine would be -2.
Also canine tip was increased by +2 to
accommodate tip loss in extraction cases as
distal translation of canine take place and it is
also helpful to get better canine guidance.
Canines was also given 2 rotation to mesial
so that when it is translated distal, mesial
builtin rotation compensate the effect of distal

Selection of Bracket Prescription

Controversy

Selection of Bracket Prescription

CHAPTER

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.
On 1st and 2nd molars buccal root torque was
increased from -9 to -14.The increased torque

B
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

CHAPTER

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 vertical position of


brackets
Bracket positioning gauges
Parts of gauges
Position of the gauge during bracket
placement

Importance of axial position of brackets

Bracket placement by wire guidance

Checking axial position of brackets

Position of clinician during brackets


placement

Modifications in axial position of


brackets
Vertical position of brackets
Modifications in Vertical position of the
brackets

Prescriptions in preadjusted edgewise brackets


are built after taking prescription values from a
certain point or area on labial surface of the
tooth. The prescription built into the bracket
will work best if the brackets are placed at that
specific area. Mostly that specific area where
the brackets needed to be placed is also
pinpointed by the inventor of the prescription.
During orthodontic bonding of preadjusted
brackets the orthodontist must place brackets
accurately in vertical, mesiodistal and axial
planes as advocated for that prescription
or based on his clinical experience. These

153

accurately placed brackets will give better


control on three dimension position of the
teeth during treatment. An accurately placed
bracket will also result in better expression of
its builtin prescription and orthodontist will
need less wire bending and complex
mechanics during the course of treatment.
Mesiodistal position of brackets
It is a general saying in orthodontics that
brackets should be placed at mesiodistal center
of the teeth. This statement is partially correct as
this rule can't be applied to all the teeth. A more

Placement of orthodontic brackets

CHAPTER

clear description for right mesiodistal position


of brackets was given by Andrew1 that brackets
should ideally be placed at the mid
developmental ridge of the teeth. The correct
mesiodistal position of brackets on different
teeth is given as under.
Maxillary and mandibular incisors
Bracket should ideally be placed at
mesiodistal center of maxillary and
mandibular incisors. The mid developmental
ridge of these teeth is also present at their
mesiodistal center of the labial surface (Figure
7.1).

Figure 7.2 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

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).

Roth 2 purposed that premolars brackets should


be placed at area of maximum convexity which
is usually the mesiodistal center of the teeth and
mid developmental ridge also lies in this area.
Sometimes the area of maximum convexity lies
slightly mesial to the mesiodistal center but
degree of mesial deviation is less than that of
canines. The difference between bracket
placement on premolars and anterior teeth is
presence of a lingual cusp on premolars which
must be taken into consideration while placing
the brackets. In mandibular premolars the
buccal and lingual cusps lies at the same level in
the mesiodistal perspective. So when placing
lower premolars brackets the scribe line of the
bracket should coincide with line connecting
the buccal and lingual cusps (Figure 7.3).

154

CHAPTER

Bonding in Orthodontics
In this Chapter

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

Historically orthodontic brackets were soldered


to bands and eventually banded to teeth. As
bands need space between the contact points at
time of their placement and leave spaces
between teeth at end of treatment so they were
not a preferred method.
With the introduction of acid etching by
Buonocore 1 in 1955 banding of teeth was
eventually abandoned with time and is now only
used on molars in cases requiring special
mechanics like headgears. Extensive details
about bonding are given in almost all the text
books of orthodontics so only a brief review on
this topic would be given here.
Bonding of brackets can be done either directly
or indirectly. Steps in direct bonding of bracket
are given.
1. Tooth cleaning

189

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).

Bonding in Orthodontics

CHAPTER

Figure 8.1 Pumicing teeth with a polishing paste and


pumice powder.

Clinical Notes
Pumicing before etching is controversial 2-4
if conventional etching is done but clinician
should do pumicing if self-etching primer 5-7
is used.
2) Enamel Roughening or acid Etching
Enamel roughening or acid etching is done to
create retention areas for the adhesive on the
enamel surface.
Moisture control is important during this
step and rest of the steps that follows.
Good moisture control is provided by using
cheek/lip retractors and high volume
section. This arrangement of moisture
control is usually sufficient in majority of
the cases but in some cases where patients
have increased salivary flow, special
gadgets are available that combine lip/
cheek retractors, saliva ejectors and tongue
guards (Figure 8.2). Cotton rolls are also
used to increase moisture control. Some
clinician also uses antisialogogue like
atropine sulphate to create a dry field for
brackets bonding. Antisialogogues can be
used on patients having excessive salivary
flow but evidence 8 doesn't support their
routine use during orthodontic bonding.
Before going for enamel conditioning
enamel surface should be dried with oil free
air. Enamel conditioning is conventionally

B
Figure 8.2
A Nola dry field system combining all the
necessary gadgets for good moisture control during enamel
conditioning. This system is especially helpful in indirect
bonding.

done with 35 - 37% phosphoric acid. Enamel


roughening by sandblasting has also been
proposed but sandblasted enamel yield lower
bond strength 9-13than acid etched enamel.
Sandblasting first followed by conventional
etching have also been proposed but bond
strength of brackets with this combination
technique is controversial 14, 15 than doing
conventional acid etching alone. Lasers have
also been advocated for enamel etching 16-19
either alone or in combination 20 with acid
etching. But due to high cost of lasers and
more safer application of conventional
etching the use of laser for enamel roughing
is still a novel approach in orthodontics.
In enamel etching with 37% phosphoric acid
the acid is available in both liquid and gel
form. The liquid form of the acid has

190

CHAPTER

10

Adhesive Remnants Removal


In this Chapter

Hand instrumentation for adhesive


removal
Adhesive removing pliers
Ligature wire cutters
Hand Scalers

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

Rotatory instruments
Burs
Carbide burs
Diamond burs
Steel burs
Brown and green stones
Composite burs

After orthodontic brackets removal, adhesive


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).

239

Removal of these adhesive remnants should be


done without causing any damage to enamel.

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

Chemical Method

Recycling of orthodontic brackets

Sandblasting

Ultrasonic Cleaning

Laser Recycling

Electropolishing
Adhesion Enhancement
Silane coupling Agents
Adhesion Boosters
Rotatory instruments
Flame Method
Buchman modiifed flame method
Modified Buchman method ,The Acid
Bath
Limitations of flame method
Lew and Djeng Method

255

Introduction

these circumstances are as follow.

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 chemicalcured composite resins debond1, 2 in clinical
practice under different circumstances. Some of

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

Bracket identification marks ,58,80

CP titanium,28-30

Bracket prominence,63,86,87,113,

Cracked teeth ,209

Bracket removing plier ,210,215,249

Crown Angulation ,92-94

Bracket sitting area,171

Crown inclination,99

Bracket stem,18,100,208,212,259,

Crown morphology,136,161

Brazing,13-21,38,42,209,260,

Crown remover,226

Bristle brush,240,249

Curve of Spee,117, 118,121,123,129, 132,

Broussard bracket,8

165,166, 173

Brown and green stones,243,246

Brown part,16
Buccal groove,88,93,97,127,128,133
Bunsen flame,262

Debonding plier,205,206,208,210-230

Adhesive precoated brackets,193,196

Debracketing, 203

Adhesive remnants,210,261,265,268

Adhesive removing plier 203,214,240


AISI 21,24,25

Deligation saddle,82
Dentinogenesis imperfect,194,209, 226, 256

Differential anchorage ,6,10

All Bond 2, 261

Calcium phosphate ceramics,36-38

All Bond 3, 261

Canine tie backs ,134

Alumina Brackets,36

Carbide burs,195,227,243-253

Amelogenesis imperfect,229

Casting,14,,15,18,23,27,43,47,51.260

Andrew plane,165

Central fossa,84

Antirotation,98,116

Ceramic injection molding ,18,36

Antisialagogues,190

Ceramic reinforced plastic,216,217

Aperture diameter,45,46

Chamfered slot walls,70,72

ASTM,27

Chemical Retention ,50-57,218,220

Attrition,33,34,160,161,178,229

Chromium oxide,22,26,28,

Austenitic stainless steel,24,25,32,263

Chromophores,231

Auxiliary features,77,123,

CO2 laser 234,235,252,270

Auxiliary procedures,257

Cobalt Chromium Brackets,27,50,259

Auxiliary spring ,6,65,67,

Cold working,20,23

E arch,3,4

Axial position,114,160,161,184,194

Collapsible base ,219,220,222

Edge bevel,107,108

Composite burs , 243,246,247

Edgewise appliance,7,13,64,104

Composite plastic brackets ,32,216

Elastic ligatures,72,82

Composite resin ,56,194,223,227,241

Elastic modules tie backs,132,134

Compound contoured base,57,59,104

Electrolytic solution ,259

Computer numerated milling ,16

Electromagnetic spectrum,230,231, 233, 234

Connectors,94,160,161,164

Electropolishing

Contact angle ,30,46,66,69,102

Electrothermal debonder , 229

Contact points,117,118,189,256

Embrasure,91,92,94,155,160,161,164

Contact sports,256

Embrasure line,85-90

Continuous mode ,234

Enhance polisher,249

Convenience features ,79-82

Er,Cr:YSGG lasers ,270

Corrosion resistance,17,19,21,24-

Er:YAGlasers,195,233,252,270,271

28,111,260

Erosion ,229

Counter buccolingual tip,102

Esmadent,259,271,272

Counter rotation ,116,117, 120,122 ,124-

Ethanol ,53,222

126,130,131,157

Excimer lasers ,232,233

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

(I)

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

INDEX
F

Microetched bases,42
Microleakage,192
Microretention,47,48,195,240
Mid-developmental ridge,92,93,154,156,158,165

FA point,58,121,165,171,

LA point,121,165

FACC,92,93,97,99,105,165

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

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

Facial point ,85-87

Laminated mesh base,42

Mini mesh base,42

Facial prominence ,85,86,88,90

Lang brackets,8

FDA,257

Laser structured bases,48,50,54,267,268

Moisture insensitive primer,192

Feedstock,16

LED curing light,192,195,199

Molar offset,88,90-93,98,127

Ferritic stainless steel,25

Lewis brackets,7,8

Moment arm,66,69

Fiber reinforced ,246,247

Lift off debonding plier,199,212,213

Monobond plus,261

Filling adhesive ,194

Ligature cutter,82,210,211,221,242

Monocrystalline brackets,35,37,38,55,

First order bend,61,62,163

Light wire appliance,6,9,10,172

232,233,235,265

Flame gun ,229,262,264

Line pressure,47,197,260,263,266-269

Flame method ,19,48,50,70,257,258, 262-

Lingual brackets,10,111,214,215

265,270,273

Long axis position,93,158,160,161,184

Flamepyrolytic method,260

Luting adhesive,50,53,194

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

Flash ,22,168,193,196,218,222-227,

N
Nd:YAG,35,48,233,252
Nickel allergy,19,20,22,28,30,31,33

242,266

Foil mesh base ,42,43,47


Free play,107

Non vital teeth,220,221


Notching,205,223

Frequency,224,231,251,271

Magnetostrictive scaler,224,240

Friction resistance,16-18,27,29,31,32,

Manufacturer tolerance,99,108

37,70-73

Marginal ridges,166-173

Gated pulse mode ,234

Martensitic stainless steel,25,26

Gauze or woven mesh base,42,43,46, 50

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

Gingival hyperplasia,77,209

Meccaca Monkey,228

Gold plated carbide bur,261

Mechanical Retention,42,46-48,50-

Green part ,16

52,54,55,218

Hand scaler,240,243

Mechanotherapy,107,109,126,130

Hard tissue lasers,231

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

Headgear tube,82

Mesh diameter,44,45

HEMA,227,228

Mesh gauge,44

Horizontal slot,5,10,65,80

Mesh number,44-46,50,267

Howe plier,208,212

Mesh type bases,48,50

Hybrid copolymer,32

Mesial offset,90,122,126

Hydrofluoric acid,195

Mesial translation,95,96,124,125

Implants,28,34,161,162

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

Passive self ligating

Impulse debonding,205,226,227

Mesiobuccal groove,88,91,92

brackets,10,72,73,109,264

In and out bends,8,9

Mesiodens,161,162

Pellicle,189

Indirect bonding,169,190,195,198,256

Mesiodistal Crown tip,92

Peppermint oil,222

Integral bases,47

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

Perforated bases,42,43

Interarch relationship,84

Mesiolingual cusp,84,91,92,127

Phosphoric acid,190,195,240

Isopropyl alcohol,264

Metal injection molding,14-18,27,47

Photoablation,232,235

Kinetic energy,227

Metal sintered bases,48

Photoetched bases,42,47

Kobayashi hook,78

Metallic luster,263

Photon,231

KrF Lasers,270

Micro mesh base,42

Piezoelectric scaler,224,240

(II)

O
Occlusal plane,92,93,9799,105,106,112,117,127,129,133,135,
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

INDEX
Pin and tube appliance,4

Separators ,199

Torque in the Base,58,100

Plasma arc curing light,192

Shape of brackets,80

Torque in the face,58,59

Plasma coated brackets,48,50

Siamese bracket,7

Torque play,15,72,107,108,110

Plastic Brackets,14,19,31-34,51-53,68-71

Side cutter,210,213,223

Torque zone,112

Plastic injection molding,19,31

Silane coupling agent,50-

Torqueing springs ,63,79

Plastic primer,51

54,195,260,261,264,269

Tribochemical method ,260,261

PoGo polisher,247,250,253

Silica coating,52,261,264,269,

True twin brackets ,68,69

Polyacrylic acid,191,222

Silica lined slot,70

Tungsten carbide bur,244-253,261

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

Silicon tray,196,197

Twin bracket,7,35,56,68,69,208

Polymer mesh base,51,54

Single mesh base,42,44,269

Twin wire appliance,6,7

Polyoxymethylene Brackets,31,32

Single slot brackets,7,67

Polyurethane brackets,31,32

Sintering,16-18,26,35,36

Porcelain veneers,195

Slip planes,218

Power arms,77-79,81,94,95,99

Slot base,71,72,86,87,105,

Preadjusted edgewise

110,116,117,208

Ultra pulse mode ,234

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

Slot creep,32

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

Precious metal brackets,21,30,31,51

Slot point,58,77,86,87,94,95,116

Ultrasonic debonding ,22,224-227

Precipitation hardening,25,26

Slot rotation,116

Ultraviolet light ,233

Prescription,9,10,15,22-24,61-63,67, 69,

So flex discs,247,248,253

Universal brackets ,6,7

83,87,90-96

Sodium bicarbonate,259,272

Primer 31,32,51.190,191,199,260, 261, 270

Soft tissue lasers,231,233,234

Protective goggles ,194,195,222

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

Pulse mode ,231,234

Speed brackets,166

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

Standard brackets,61,69,95,100,
102,119,120,129

R
Recycling ,110,198,206,208,209,215,227,251,255

U
V
Van der Waal forces ,227
Vertical groove ,93
Vertical Mid Scribe line,79

Steel burs,139,243

Vertical slot ,5,7,8,61,65,67,79,80,219

Steel ligatures,34,72,109

Vickers hardness,17,23,109

Straight wire appliance,8,9,58,84,94,


100,102,117,119,162

Replaceable tips,221

Super Austenitic Stainless steel,25

Resin modified Glass ionomer cement,56,194

Super Ferritic stainless steel,25

Ribbon arch appliance,4-6,61

Super pulse mode,234

Wagon wheel effects,114,115,119,132,

Roller coaster effects,34,121

Super snap discs,247,248

134-136

Super torque,123,127,128,131,136,141

Wavelength ,192,230-235,270

Supermesh base,44,50

Weingart plier,212,219,220

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

Wick stick,167,181

Wing method,19,205-210,212,214-217,
219,257,260
Wire bevel,108

Thermal ablation ,232,235

Wire diameter ,44-46,267

Thermal softening ,232,234,235

Wire guidance,110,143,163,183,184

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)

Z
Zirconia Brackets,36,38

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