Year : 2017 | Volume
: 8 | Issue : 1 | Page : 3--4
Accurate bracket positioning as a prerequisite for ideal orthodontic finishing
Raed H Alrbata
Department of Orthodontics, Royal Rehabilitation Center, Royal Medical Services, Amman, Jordan
Raed H Alrbata
Department of Orthodontics, Royal Rehabilitation Center, Royal Medical Services, Amman
|How to cite this article:|
Alrbata RH. Accurate bracket positioning as a prerequisite for ideal orthodontic finishing.Int J Orthod Rehabil 2017;8:3-4
|How to cite this URL:|
Alrbata RH. Accurate bracket positioning as a prerequisite for ideal orthodontic finishing. Int J Orthod Rehabil [serial online] 2017 [cited 2019 Sep 21 ];8:3-4
Available from: http://www.orthodrehab.org/text.asp?2017/8/1/3/200223
Brackets are considered as the key constituent of the fixed orthodontic appliances used for the treatment of different malocclusions. Besides the different types of orthodontic archwires that are inserted into the bracket and ligation methods used, a three-dimensional (3D) configuration of tooth positioning is usually established.
To achieve this, utilizing the straight wire technique, an accurate bracket positioning is needed to effectively express the built-in prescriptions that are differently programmed into the different types of bracket systems available in markets. However, especially in direct bonding technique, it is difficult to do this and later wire bending at the finishing stage might be needed to get the desired result of the orthodontic treatment.
In literature, a wide variety of researches investigated the proper bracket positioning for different malocclusions. Andrews, the genuine designer of straight wire technique, postulated that in order to express the treatment built into the bracket correctly, the base point of each bracket should be positioned over the facial axis (FA) point of the corresponding tooth with the bracket aligned parallel to the FA of the clinical crown (FACC). An ideal bracket placement point is the one that should closely simulate the center of rotation or resistance of the tooth at which the proper tooth movement of either tipping or bodily movements will be accurately achieved.
Multiple factors have been reported to affect the ideal bracket site. Configurations of the clinical crown including height and morphology, incisal edge abnormalities, and considerations of the vertical intermaxillary correction needed have been investigated. These factors were found to affect the FACC angulation, FA point height, and FA point mesiodistal location.,,,
Bracket positioning is at risk of inaccuracy not only between different clinicians but also between different areas bonded by the same operator. For this, the development of customized orthodontic philosophy and the incorporation of digital orthodontics have given the glimmer of hope to eradicate the problem by giving the clinicians the ability to build up the proper bracket prescription needed for every patient malocclusion and to transfer each bracket to a specific point at the tooth surface already chosen to help represent the best 3D positioning of the tooth according to treatment plans outlined.
In fact, it is getting clear nowadays that the future of orthodontics will be primarily dependent on the concept of digital orthodontics. Regardless of the available techniques used, the best appliance prescription should be targeted so that when the customized brackets are transferred accurately to the tooth surface and with the use of the suitable archwires, the best orthodontic results for both patient and orthodontist will be effectively and satisfactorily achieved. However, cost of such techniques might be considered as the main factor to negatively affect the wide spreading of these techniques, especially during their introductory incorporation. Meanwhile, conventional techniques related to the appliance design, mechanics used, and operator factors should be re-considered and optimized. Selection of the best brackets prescription according to the case demands, bonding brackets with even adhesives and pressure used, considering crown morphology, taking panoramic X-ray view at the end of rectangular alignment archwires, and assessment of root positioning and repositioning brackets if needed, all of these and more, may help reduce errors appear at the finishing orthodontic stage so that less finishing mechanics needed to end up with the best result of the orthodontic treatment.
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