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Characteristics of an ideal bracket site

a bracket located there will not interfere with the gingivae or opposing teeth during occlusion the angulation and inclination of the crown at the site will have a consistent angular relationship to teach tooth's occlusal surface and occlusal plane at all times

the middle of each bracket site 5/18/12 must share the same plane or

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Bracket Positioning: General Instructions

There are many different systems for bracketing teeth. Recommended bracket height will vary depending on manufacturer and system.

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Bracket Positioning: General Instructions

Dimple or paint dot identifies disto-gingival Center each bracket on the crown long-axis Vertical slot between the bracket wings parallel to the crown LONG AXIS

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Mesio-distal positioning is often best viewed in a mirror similar to checking a crown prep for parallelism.

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Position of bracket on tooth


bizarre

variation.

Saltzmann:

brackets should be placed in the middle third of the crown. : brackets be placed on the gingival third of the crown if there is an anterior open bite, in the middle third of the crown if the overbite is normal and in the

Holdaway

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Ortho CAD bracket placement solution


generates

a computerised 3-D model from alginate impression and a bite registration.

computerised setup is then completed and the pretreatment and posttreatment 3D simulations transmitted to the orthodontist. The orthodontist can, using local software, modify the proposed setup if necessary. 5/18/12

advantages of the technique are:

the effects of bracket positioning on the final result can be visualised before bracket placement bracket positioning can be fine tuned bracket positioning can be carried out more easily by orthodontic therapists or chairside operators

it can be used for direct or indirect 5/18/12

Direct Bonding:
Bonding

of Brackets Directly on the Facial Surface of the Teeth

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Bonding technique

patients

over the age of 12 years are given a 200 milligram ibuprofen tablet

The patient is given a 600 microgram tablet of atropine sulphate


take it

one hour before the bonding appointment. does provide a very dry field which almost eliminates the need for a saliva 5/18/12

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1.

All of the teeth are cleaned using a mixture of fine flour of pumice and water. The teeth are then isolated with a cheek retractor and good saliva evacuation is performed. The teeth are washed and dried with air water spray. Maintain a dry field and keep the tongue out of the way. 3. the facial surface of each tooth is

2.

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4.

The teeth are desicated to expose a chalky or frosted appearance, indicating an adequate etch has been achieved. The facial surface of each tooth is sealed with an unfilled resin (or sealant) and light cured for 5 10 seconds.

5.

It is advisable to begin bonding in 5/18/12 mandibular arch, as it is the the

6.

7.

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Cotton pliers or special bracket placing instruments are used to transfer the bracket from the bracket set up to the tooth. The doctor places the bracket carefully using firm pressure to express excess material, removes the excess material and idealizes mesio-distal and inciso-gingival bracket placement.

The bonding sequence is as shown in Figure 6.2

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Bracket

adjustment is done with an instrument that will fit into the archwire slot of the bracket and allow manipulation of the bracket.

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Indirect bonding
involved

applying mixed cement to each bracket in a transfer tray, a process that requiring a slow setting adhesive and subsequently necessitating flash removal of set adhesive.

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The advantages of indirect bonding are:


more accurate bracket and tube placement better use of the orthodontists time no need for separators; avoids band fitting on posterior teeth

makes it easier to bond posterior teeth 5/18/12

The disadvantages of indirect bonding are:


it is technique sensitive

an additional set of impressions are required bonded posterior attachments more vulnerable than bands may require the use of an antisialagogue

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Maxillary Upper

Teeth

Central Incisors

Distance As

from the slot to the incisal edge = 4mm a guide, approximate the incisal

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Upper Lateral Incisor

Distance As

from the slot to the incisal edge = 3.5mm a guide, approximate the incisal with the slot to align the

edge

archwire slot perpendicular to the clinical crown long axis.


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Upper Cuspids
Distance

from cusp tip to bracket slot =

4.5 mm

4.5

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Upper Bicuspids
Distance

from cusp tip to bracket slot = 4

mm
Upper is

bicuspid bracket placement

the most difficult due to individual the brackets are not placed

variability in tooth morphology. gingivally enough, especially on


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Often

smaller sized or partially erupted

Mandibular Teeth Lower Incisors


Distance Position

from incisal edge = 4mm

the archwire slots so that the incisal edges of the incisors will be 0.5-1 millimeter shorter gingivally than the cuspid tip after initial alignment. the incisal edge and the base

With

of the bracket as a guide, align bracket wings parallel to the clinical crown long axis and the base of the
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Lower cuspid
Distance checking

from cusp tip = 4.5 mm

carefully that a vertical line through the bracket wings is parallel with the clinical crown long axis.

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Lower bicuspids
Distance Bracket Direct

from cusp tip to bracket slot = 4 mm slot parallels the marginal ridges and contacts vision of the facial surface is important to properly positioning the bracket relative to the marginal ridges

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brackets Vertical position of bracketspositioning of brackets The vertical


may be adjusted to facilitate treatment. Thus in deep bite cases thebrackets may be placed slightly occlusally and in open bite cases slightly gingivally on the incisors. Incisors have relatively flat labial surfaces and so adjustment of vertical position has little if any effect on torque. 5/18/12

Over angulating brackets


Where

teeth have to translated a significant distance (such as in pseudotransposition cases) there is increased tendency to tip and so the brackets should be angulated to prevent this; this often requires a significant over angulation of the bracket.

A similar situation occurs where implants are to be placed post 5/18/12

Inverting brackets
changes

its torque and rotation but not its in/out or tip. The brackets commonly inverted are lateral incisors and canines.

general, inverting a bracket on its own rarely produces enough torque to correct the problem one is trying to deal with and additional torque needs to be bent into the arch wire 5/18/12 optimise the final position of the to

In

Inverting

Roth prescription lateral incisor brackets changes their torque from 8 to -8 which is helpful when moving a palatally placed lateral incisor into the line of the arch.

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Positioning Errors
The

most important factor in aligning teeth using contemporary orthodontic techniques is precise bracket positioning. Proper bracket position is critical if our treatment objectives are to be achieved with the preadjusted bracket (straight wire appliance). The correction of bracket placement

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Band or bond?
We routinely bond incisors, canines, premolars and molars; banding molars is now a very, very rare event. The reasons against bonding molars are as follows: the inferior quality of etch pattern obtained on molars the difficulty in obtaining and maintaining adequate moisture control 5/18/12

We

now bond all teeth including molars routinely unless bands are specifically required for the attachment of a palatal or lingual intraoral auxiliary. The use of low profile bonding tubes, improved moisture control, bond enhancers and improved adhesives make this an achievable goal.

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Moisture control
Moisture

control remains critical in the bonding process. It is still preferable to bond in a clean dry and uncontaminated field. Steps to achieve this include: consider the use of an atropine sulphate tablet as suggested for indirect bonding. Although

everybody will wish to do this, it 5/18/12 does provide a very dry field which

not

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Bracket

Bonding

Optimal performance in bonding of orthodontic attachments offers many ADVANTAGES when compared with conventional banding. 1. It is esthetically superior 2. It is faster and simpler 3. It results in less discomfort for the

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DISADVANTAGES

of bonding are;

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1. A bonded bracket has a weaker attachment than a cemented band. Therefore it is more likely that a bracket will come off rather than that a band will become loosened. 2. Some bonding adhesives are not sufficiently strong. 3. Better access for cleaning does

The

recommended bracket bonding procedure consists of the following steps; 1. 2. 3. 4. Transfer Positioning Fitting Removal of excess

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1. Transfer

Bonding

to Crowns and Restorations

Many adult patients have crown and bridge restorations fabricated from porcelain and precious metals, in addition to amalgam restorations of molars. Banding becomes difficult, on the abutment teeth of fixed bridges.
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Bonding

to Porcelain

Following technique is recommended 1. Isolate the working field adequately. 2. Deglaze an area slightly larger than the bracket base by sandblasting with 50 micro meter aluminium oxide for three seconds.

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Bonding

to Composite Restoratives

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The bond strength obtained with the addition of a new composite to mature composite is substantially less than the cohesive strength of the material. Brackets bonded to a fresh, roughened surface of old composite restorations appear to be clinically

debonding
In

addition, self-ligating brackets have much more bracket bodies which are harder to deform on The conventional method of 'snapping directly bonded brackets with a small, sharp rotation of the wrist works well on

rigid

debonding. off' 5/18/12

The

best way to removed selfligating brackets is to use AEZ 90 debonding pliers1 and squeeze firmly but on one pair of tiewings only as shown in Figure 6.4; the bracket will (noiselessly!) separate from the

gently

surface. It is not necessary to twist or rotate the bracket it just 5/18/12 floats off the tooth! Situations

enamel

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