MBT™ Bracket Placement Technique

Elimination of such errors can be best achieved by visualizing the vertical long axis of the crown directly from the facial surface. Excess bonding agent beneath the bracket base can cause thickness and rotational errors. These can normally be avoided with careful technique. Such errors can be eliminated by using the same techniques described for the elimination of horizontal errors. 1).M c L a u g h l i n . errors or potential deviations from this desired position can occur as follows: F I G U R E 1 F I G U R E 2 F I G U R E 3 Horizontal bracket placement errors. Brackets can be rotated off the vertical long axis of the clinical crown if the bracket wings do not straddle the long axis of the crown in a parallel manner (fig. 2). in a parallel fashion. These can normally be avoided with careful technique. as well as from the incisal or occlusal surface with a mouth mirror. T r e v i s i MBT™ Bracket Placement Technique Traditionally. Such errors lead to improper crown tip and can also be avoided by viewing the crown directly from the facial surface. the vertical long axis of the clinical crown. . leading to improper tooth rotation (fig. it has been recommended that pre-adjusted appliance brackets be placed with the twin bracket wings straddling. Axial or paralleling bracket placement errors. Some orthodontists even consider drawing a line through the vertical long axis of the clinical crown for more accurate visualization. B e n n e t t . and that the center of the bracket slot be placed on the 1 center of the clinical crown. as well as from the incisal or occlusal surface. Potential Horizontal errors Axial or paralleling errors Brackets can be placed to the mesial or distal of the vertical long axis of the clinical crown.

when treating young patients. It is difficult to visualize the center of the clinical crown on partially erupted teeth. as well as potential torque and in/out errors. (as Andrews stated1). so that excessive adhesive flows from beneath the bracket. The apparent clinical crown is foreshortened. or by contouring the bracket base to more accurately fit the tooth surface. or if the contour of the tooth does not correspond accurately to the contour of the base of the bracket. with the tendency to place the bracket too occlusally or incisally. Such errors can cause improper tooth torque or rotation. 3). Vertical bracket placement errors occur when the bracket is placed gingival or incisal/occlusal to the center of the clinical crown (fig. Bottom: The same case with inflamed gingivae in the upper right quadrant. 1. Such errors lead to extrusion or intrusion of teeth.6) causes foreshortening. and the tendency is to place the bracket too incisally or occlusally. Gingival inflammation. especially with bicuspids and lower second molars. . and can be eliminated by pressing the bracket against the tooth at placement.M B T B r a c k e t P l a c e m e n t T e c h n i q u e Thickness errors Vertical errors Gingival Concerns Such errors can occur if excessive adhesive is left underneath one portion of the bracket base (fig. direct visualization is more difficult. in the following clinical situations (which occur quite frequently). It is difficult to locate the center of the clinical crown on partially erupted teeth (fig. 2. Therefore. Gingival inflammation causes foreshortening. Partially erupted teeth. 5) when treating young patients. However. effectively reducing the length of the clinical crowns. F I G U R E 4 F I G U R E 5 F I G U R E 6 Vertical errors in bracket placement are caused by placing brackets gingival or incisal/occlusal to the center of the clinical crown. The human eye is quite accurate at bisecting and locating the center of a given object such as a crown. Gingival inflammation (fig. 4). brackets can be placed accurately using direct visualization on fully erupted and anatomically normal teeth. Top: Healthy gingivae.

or by estimating how long the crown was before fracture or wear. portion of the clinical crown than normal. and functionally they will create an interference with the opposing dentition. Crowns with long tapered buccal cusps. adjacent marginal ridges will not be properly aligned. 8). Proportionally long clinical Incisal or Occlusal Concerns crowns. T r e v i s i F I G U R E 7 3. This situation can be corrected by selectively reducing the height of the cusp prior to bracket placement. roots. these crowns will be too long. Correction of this problem can be made by either restoring the crown to its appro- F I G U R E 9 priate length. 11mm Proportionally long or short clinical crowns 1. With such teeth (fig. This is a common occurrence with cuspids. producing a shorter clinical crown. creating a tendency to place the bracket F I G U R E 8 too gingivally (fig. is foreshortened. Such teeth tend to show a lengthened clinical crown.M c L a u g h l i n . an inherent esthetic and occlusal error will be created if the brackets are placed in the centers of the clinical crowns. Teeth with facially displaced Individual teeth with lingually displaced roots can produce short clinical crowns. . 7). 10). With such teeth. Incisal or occlusal crown fractures or tooth wear. Occasionally a crown on a tooth such as a cuspid or bicuspid will show an unusually long and tapered buccal cusp (fig. gingival tissue covers a greater 11mm 2. The tendency is to place the bracket too incisally 10mm or occlusally (fig. 4. B e n n e t t . If the bracket is placed in the center of the clinical crown. When individual clinical crowns are proportionally longer than the mean for the individual’s dentition (frequently seen with the upper central incisors). 9) it is difficult to visualize 12mm the center of the clinical crown since the apparent clinical crown Individual teeth with facially displaced roots can produce long clinical crowns. In 1. Teeth with palatally or lingually displaced roots. Incisal crown fractures or tooth wear make it difficult to visualize the center of the clinical crown. Esthetically.

and if necessary must be corrected in the finishing stages of treatment with archwire bends.M B T B r a c k e t P l a c e m e n t T e c h n i q u e this situation. While this adjustment may produce a minor error in the torque relationship and thickness relationship of these teeth. While this adjustment may also produce a minor error in the torque relationship and thickness relationship of these teeth. it is necessary to place brackets slightly gingival to the center of the clinical crown. This study was published in May 1995 in the Journal 2 of Clinical Orthodontics. and functionally they will be out of contact with the opposing dentition. The bracket placement chart is shown in Table 1. an inherent esthetic and occlusal error is also created if the brackets are placed in the centers of the clinical crowns. When clinical crowns are proportionally shorter than the mean for the individual’s dentition (sometimes seen with the upper lateral incisors) (fig. a study was carried out to provide a method that could serve as a supplement to the direct visualization technique. the problem is normally minimal. F I G U R E 1 1 In an attempt to reduce the errors inherent in using only a direct visualization method of bracket placement. Proportionally short clinical crowns. and if necessary must be corrected in the finishing stages of treatment with archwire bends. 11). This in turn allowed for more accurate vertical bracket placement in the above clinical situations. F I G U R E 1 0 Cuspids with tapered clinical crowns often do not have adequate contact with the opposing teeth. the problem is normally minimal. it is necessary to place brackets slightly incisal to the center of the clinical crowns of the oversize teeth. The result of this study was the development of a bracket placement chart which aided in the location of the center of the clinical crown for each individual patient. Case with large (and disproportionately sized) upper central incisors and small lateral incisors . 2. Esthetically. In this situation. these crowns will be too short.

5mm -1.0 4.0 4.0 4.5 4.0 3.5 4.0mm +0.0 3.5 3.5 U3 6.0 4.5 4.5 2.5 U1 6.5 2.5 4.5 3.0 2.0 4.5 L2 5.0 U4 5.0 3.0mm L7 3.0 3.0 4.0 3.0 L3 5.0 4.0 3.0 L6 3.5 4.5 5.0 2.5 5. . Highlighted figures represent the three minor maxillary arch changes and the three minor mandibular arch changes that were made from the initial Bracket Placement Chart.5 4.0 4.5 4.0mm +0.0 2.0 +1.0 U6 4.0 2.5 3.5 4.5 2.0 2.5 5.0 L1 5.0 2.5 5.0 3.0mm s Table 1.5 L4 5.M c L a u g h l i n .0 4.0 5. T r e v i s i R E C O M M E N D E D B R A C K E T P L A C E M E N T C H A R T U7 2.5 3.5 3.5 3.5 4.5mm -1.0 U2 5.0 3. B e n n e t t .0 +1.0 L5 4.0 2.0 5.5mm Average -0.5mm Average -0.5 4.0 2. These changes were based on evaluations of the American Board-Angle Society case measurements and cases measured at the debanding appointment.5 3.0 U5 5.0 2.5 5.0 2.0 3.5 3.

and esthetic height problems. an appropriate millimeter adjustment needs to be made to allow the crown to be properly positioned. or on crowns with unusually long tapered facial cusps. Step three The row on the bracket placement chart that contains the greatest number of recorded figures is selected for bracket placement. This alone is a major advantage. When these situations occur. lack of occlusal contact.5 mm to obtain measurements for the distance from the incisal or occlusal surfaces to the center of the clinical crowns. It also eliminates the difficulty presented with proportionally large or small teeth within the dentition. The Bracket Placement Chart allows for this adjustment. Step two These figures are recorded. . When these teeth are present. since the majority of vertical bracket placement errors that do occur are the result of inability to accurately visualize the gingival half of the clinical crown.DISCUSSION Use of the Bracket Placement Chart (table 1) eliminates potential gingival errors because measurements are made from the occlusal or incisal edge of the teeth. The only potential errors that cannot be avoided are on crowns with incisal or occlusal fractures or wear. The technique that has been developed for bracket placement with this method is as follows: Step one Dividers and a millimeter ruler are used to measure the clinical crown heights on as many fully erupted teeth as possible on the patient’s study models. divided in half and rounded to the nearest . it is necessary to place the bracket slightly off of the center of the clinical crown in order to avoid occlusal interferences.

Because of the possible presence of proportionately large teeth (i. or to place an anterior bite plate until bite opening occurs.e. or to place all brackets proportionately more gingival on the lower arch. brackets are placed by visualizing the vertical long axis of clinical crowns (buccal groove on the molars) as a vertical reference and the estimated center of the clinical crown as a horizontal reference. when crowns show incisal or occlusal wear or fracture. with fewer cases requiring bracket repositioning due to vertical placement errors. to allow the interference to occur until bite opening is achieved. B. T r e v i s i A. an appropriate millimeter adjustment must be made to assure correct position of these crowns. It has also been most helpful in the repositioning procedures required on cases bonded and banded prior to the development of the Bracket Placement Chart. When this occurs the choices are to allow the interference to occur until crown uprighting occurs. Step five gingivally and place a step bend to avoid extrusion of the tooth. there is always the potential for interferences with the upper dentition. The specific decision to be made in each case is dependent on the clinical situation.e. As stated above. A bracket placement gauge is then used to confirm that the brackets are at a height that represents the appropriate figures in the selected column of the bracket placement chart.M c L a u g h l i n . B e n n e t t . to place the effected bracket more At the time of banding and bonding. With the placement of any Step four The authors have tested this method of bracket placement on a variety of cases for over three years and have found that it has improved treatment efficiency during leveling and aligning. For direct bonding procedures. . The authors prefer to use the bracket positioning instruments from 3M Unitek. it is generally due to lingually inclined crowns which elevate the position of the bracket on the buccal surface. or excessively long tapered cusps. it is normally due to the presence of a deep overbite. upper lateral incisors) some recorded figures will be larger or smaller than the numbers in the selected column and in turn in the numbers used for bracket placement on these teeth. When the interference occurs in the incisor region. to place an upper anterior bite plate and eliminate the interference. The choices in this situation are to leave brackets off of the lower incisors until bite opening occurs. A. the use of a light curing adhesive system is most beneficial since slightly more time is required to assure correct positioning with the bracket placement gauge. upper central incisors) or small teeth (i. When this situation occurs in the molar region. bracket on the lower arch.

5 mm. C. REF.5 mm. However in situations in which there are gingival variations. Journal of Clinical Orthodontics May 1995.: “Bracket Placement with the Pre-adjusted Appliance” . A bracket placement chart was developed that allows the orthodontist to select a set of numbers representing the average center of the clinical crown for a given patient.0 –4. 29: 302-311. or incisal or occlusal variations.: 2. Measurement gauges can then be used to check bracket positions after visual placement. The technique has been used in the practices of the authors for several months and has dramatically reduced the need for bracket repositioning due to incorrect visualization of the center of the clinical crown. 900-836 3. L. J. . . Wells Company. 900-837 4. this direct visualization technique becomes more difficult. Los Angeles. 1989.M B T B r a c k e t P l a c e m e n t T e c h n i q u e SUMMARY AND CONCLUSIONS Direct visualization of the center of the clinical crown is a satisfactory method of locating this point on fully erupted and anatomically normal teeth.5 mm. 900-839 3M Unitek Bracket Positioning Gauges are offered individually or as a kit of 4 instruments. REF.Andrews. differences in tooth size within the dentition. Such situations do occur quite frequently in an orthodontic practice.The Concept and The Appliance.0 –3.5 mm.0 –5.Mclaughlin.0 –2. REF. P and Bennett. 2. REFERENCES 1.F Straight-Wire . R. 900-838 5. REF.

3M Unitek Dental Products Division 2724 South Peck Road Monrovia. Printed on 50% recycled waste paper. MBT and Unitek are trademarks of 3M Unitek Corporation.S. contact your local representative. CA 91016 In U. ©1998 3M Unitek Corporation 16-888-1 9807 . and Puerto Rico: 1-800-423-4588 In Canada: 1-800-443-1661 Technical Hotline: 1-800-265-1943 Outside these areas. including 10% post-consumer waste paper.

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