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sistance, play between wire and slot, or force of tissue impingement, trapped food, and plaque,
diminution. while making archwires easier to tie. When elas-
If teeth were moved through air or the “vir- tics are needed, a simple hook pin or T-Pin***
tual reality” of a computer simulation,11 the can be inserted into the vertical slot of any brack-
preadjusted prescription would always work. In et—virtually eliminating the need for Kobayashi
reality, however, a straight wire never becomes ties, soldered hooks, and crimpable surgical
entirely straight. Consequently, it is not enough hooks.
simply to plan for ideal tooth positions; some One of the simplest uses of the vertical slot
overcompensation or overcorrection is needed in is for teeth that are blocked out, lingually dis-
the prescription.12 placed, or ectopically erupted. In these instances,
The misconception that preadjusted appli- it is nearly impossible to tie an archwire into the
ances require no wire bending may contribute to bracket during early alignment, but a stainless
some of the failures observed by the ABO. Su- steel ligature or elastic thread can be placed
perb results may be obtained with virtually any through the vertical slot to form a vertical or
appliance or prescription if there is enough atten- “sling” tie around the archwire (Fig. 3). A loose
tion to detail and wire bending. Still, if bracket stainless steel tie, especially a single vertical tie,
prescriptions were modified to account for com- produces even less friction than a self-ligating
mon errors, perhaps the effectiveness and effi- bracket.
ciency of these systems could be improved. That
**Trademark of American Orthodontics, Inc., 1714 Cambridge
was the basis for developing a hybrid, third-gen- Ave., Sheboygan, MI 53082.
eration appliance, as described in this article.13 ***TP Orthodontics, Inc., 100 Center Plaza, La Porte, IN 45350.
Butterfly System
The Butterfly System** is based on a new
low-profile, twin-wing bracket (Fig. 1). The
bracket’s reduced profile, its miniature twin-
wing design and rounded tie wings, and the elim-
ination of standard hooks results in an appliance
that is more comfortable, esthetic, and hygienic.
The Butterfly System has several unique
features designed to improve upon existing
preadjusted appliance concepts, in response to
the findings of the ABO. These are outlined
below.
A series of vertical-slot auxiliaries has also improve the effectiveness of mesial molar move-
been developed. The U-Turn Rotating Spring,** ment in cases where it is desirable to “slip
a unique square-wire spring, can be inserted into anchorage”, such as with congenitally missing
the square vertical slot on any bracket to help second premolars.
correct severe rotations (Fig. 4). The universal,
friction-fit U-Turn can be inserted from either the
Progressive Posterior Torque
occlusal or the gingival for clockwise or counter-
clockwise rotations. The most common deficiency of finished
The Compliance Spring** is an auxiliary cases presented by either orthodontic residents or
that can be used for two distinct purposes. With a successful ABO candidates is improper buccolin-
round archwire, an intermaxillary elastic from gual inclinations.1,15 Torque is not efficiently
this spring will produce labial root torque for a expressed with preadjusted appliances, because
specific tooth, such as a lingually displaced max- the area of torque application, which depends on
illary lateral incisor (Fig. 5A). With a rectangular the twisting effect of a thin wire, is quite small
archwire, the Compliance Spring can also be compared with the bulk of the tooth.5,12 In addi-
used to encourage cooperation with elastics (Fig. tion, most practitioners do not use full-size arch-
5B). If the elastic is not worn, the spring will pro- wires of sufficient stiffness to express torque; for
trude enough to provoke a mild irritation of the example, an .019" × .025" wire in an .022" ×
cheek. .028" system has about 10° of play.
The Power Arm** was designed as a cou- Many bracket prescriptions contain an
ple to apply forces from elastic chain, closed- extreme amount of mandibular posterior lingual
coil springs, or intraoral elastics closer to the crown torque, intended to obtain so-called “cor-
tooth’s center of resistance (Fig. 6). This tech-
nique can help prevent tipping during space clo-
sure or retraction.
Traditional Begg uprighting springs*** are
useful for root paralleling. When placed in the
mandibular canine and/or first premolar brackets,
they produce mesial crown tip that can counter-
act retraction forces on the mandibular anterior
teeth14 (Fig. 7). Springs used in this configuration
**American Orthodontics, Inc., 1714 Cambridge Ave., Sheboygan,
MI 53082. Compliance Spring is a trademark. The Power Arm is A
not yet commercially available, but can be bent in the office from a
straight wire segment.
***TP Orthodontics, Inc., 100 Center Plaza, La Porte, IN 45350.
B
Fig. 5 A. Compliance Spring used with round
stainless steel archwire and intermaxillary elas-
tics to provide labial root torque. B. Compliance
Spring reinforces wear of Class II elastics when
Fig. 4 U-Turn square-wire rotating spring (arrow). used with rectangular archwire.
TABLE 1
BUTTERFLY SYSTEM
PRESCRIPTION (°)
A B
Fig. 16 A. 14-year-old female patient treated without extractions (patient
shown in edge-to-edge position, not in occlusion). B. After 21 months,
note improved root angulation of mandibular anterior teeth. C. Progres-
sive anterior angulation in Butterfly System produced “tent-posting” of
incisors. C
C
Fig. 19 A. 13-year-old female patient treated without extractions.
B. After 12 months, note improved buccal cusp position due to angula-
tion of attachments on Butterfly System’s first molar bands. C. Im-
proved root paralleling and angulation of first molar (from panoramic x-
B rays).
C
Fig. 20 A. 13-year-old male patient treated with combination of Distal Jet and Jasper Jumpers. B. Improved
maxillary incisor position; lower incisor brackets with –10° lingual crown torque limited incisor flaring from
fixed functional appliance (no change in IMPA). C. After 34 months of treatment.
A
B
C
E
E
Fig. 21 A. 12-year-old female patient treated with Class II Combination Therapy (Distal Jet followed by Jasper
Jumpers). B. Esthetics and oral hygiene improved by Butterfly System’s low-profile brackets without hooks.
C. Jasper Jumpers used between stages. D. T-pins inserted into vertical slots only when intermaxillary elas-
tics were required. E. After 24 months of treatment. Lower incisor angulation was maintained (no increase in
IMPA) by using optional –10° torque brackets.
A B
Fig. 22 A. 16-year-old female patient with Class II, division 2 malocclusion treated with Class II Combination
Therapy (molar distalization followed by fixed functional appliance). B. Patient after 36 months of treatment.
A B
Fig. 23 A. Maximum Retention bonding pad. Fig. 24 Optional offset and standard Butterfly
B. Photoetched pockets beneath mesh pad System premolar brackets. Offset pads increase
increase surface area for bonding adhesive. surface area to enhance bond strength.
Excessive lingual crown torque of the maxillary fly System (reduced mandibular and increased
canine produces lingual displacement compared maxillary torque) helps prevent flared maxillary
to the other anterior teeth11 (Fig. 15). This is es- molars and rolled-in mandibular posterior teeth.
pecially important when attempting to maintain It is also important, whenever possible, to select
the roots within the cancellous bone during an archform that is consistent with the patient’s
retraction mechanics.12 McLaughlin and col- pretreatment anatomical shape while maintain-
leagues recommended no torque for canines that ing the pretreatment intercanine width.5,12 Arch-
are prominently positioned in the pretreatment forms should be coordinated throughout treat-
archform.12 To prevent lingual displacement of ment with these principles in mind (Table 2).
the canines and to split the difference between
the extremes, the Butterfly prescription has no
Bonding Pad Enhancements
torque in the maxillary canine brackets.
A similar situation exists with popular The Maximum Retention** bonding pads
mandibular canine prescriptions, which range on Butterfly System brackets have photoetched
from –11° to +7° of torque. To match the reduced pockets beneath the mesh to enhance bond
progressive posterior torque of the Butterfly strength (Fig. 23). Optional offset bases on the
System, the mandibular canine features a moder- premolar brackets provide larger bonding sur-
ate –3° of torque. In deep-bite cases, the canine
bracket can be inverted (+3° torque) to move the
crown labially while keeping the roots within the TABLE 2
supporting bone.5,12 TYPICAL ARCHWIRE SEQUENCING
WITH BUTTERFLY SYSTEM
Improvements in Overjet (NATURAL ARCH FORM III**)
The fourth most prevalent error noted by .016" nickel titanium
the ABO was inappropriate overjet, with two- .019" × .025" nickel titanium
thirds of these problems in the posterior teeth. .019" × .025" stainless steel
When overexpanded commercial arch blanks are Upper .019" × .025" beta titanium T-loop
combined with bimaxillary expansion therapies, Lower .021" × .025" stainless steel
the results may include a discrepancy in both .018" or .0175" × .0175" stainless steel for
anterior and posterior overjet, as well as flared artistic bends
molars and distally tipped incisors. The esthetic
effect is a “wider than normal smile”24 or the
“orthodontic look” described by Proffit.28 **American Orthodontics, Inc., 1714 Cambridge Ave., Sheboygan,
Progressive posterior torque in the Butter- MI 53082. Maximum Retention is a trademark.
TABLE 3
BUTTERFLY SYSTEM TREATMENT SOLUTIONS
faces that not only improve bond strength, but inates hooks. The system also accommodates the
make bracket positioning easier to visualize colorful elastomeric ligatures that many of
(Figs. 1,24). The offset also offers the option of today’s patients are requesting to personalize
placing the bracket more gingivally to improve their braces.
marginal ridge orientation. The Butterfly System prescription was
based on modifications to the second-generation
preadjusted appliance, in response to case com-
Conclusion
pletion errors documented by the ABO1,7 (Table
Design concepts of the Butterfly System 3). The intent was to take the best from the past
included esthetics, comfort, versatility, and color. while avoiding common problems, thus produc-
The miniature twin Butterfly bracket features a ing more efficient treatment and more favorable
low profile and an improved radius for the tie- results for our patients.
wing corners. Its multipurpose vertical slot elim-
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