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Evolution of Orthodontic Brackets
Dr. Tamizharasi1, Dr. Senthil Kumar2
ABSTRACT: Orthodontics distinguishes and differs itself from the other branches of medicine by its widespread use of an array of devices made of almost all the biomaterials known. From metals to plastic and from ceramics to composites, these materials bring beauty and health. Brackets evolutions from the introduction of pin and tube to lingual, magnetic and self ligating brackets are rapid in pace and play a significant role in advancement of Orthodontic field. Though, we all are using recent brackets which are currently available in the markets, it is important to know the past history of brackets which was used earlier. Thus, this article reviews the history of various orthodontic brackets and it's advantages and disadvantages. We suggest that many more review studies should come aiming at the biocompatibility, aesthetics and treatment results of each bracket. Such studies will help the practitioner to decide the bracket selection for his treatment plan.
Department of Orthodontics KSR Institute of Dental Science & Research, Tiruchengode, Tamil Nadu.
Introduction One of the most important passive components of fixed appliances is brackets. They are merely handles for attachment of the force producing agents. Brackets can affect the directions of the force vectors when torque, angulations, and in/out are built into the brackets. Orthodontic treatment is based upon specific force applications to the dentition, the maxilla and the mandible. In order to obtain these forces, orthodontic brackets are attached to the teeth. Previously, brackets were banded to the teeth. But, after, the introductions of bonding resin, brackets are rarely banded to the teeth. History It is difficult to imagine that there was a period in Orthodontics before the invention of brackets. Yet this was the situation when Angle developed and perfected treatment procedures with his “E” arch which provided no axial tooth control. During this time he also advocated the pre-treatment extraction of teeth and devised methods to close extraction spaces "sans" brackets. The pin and tube appliance1 overcame the weak point in his “E” arch. Thus the prototype of bracket was conceived. The problems of pin and tube appliance were overcome in ribbon arch appliance by Angle with the introduction of first orthodontic bracket – “the ribbon arch bracket”1. It had a vertical slot facing occlusally and was made in gold. The next major advancement in bracket design that had withstood the test of time was the first
edgewise bracket with a horizontal slot (0.022” x 0.028”). Ever since many modifications had come in bracket design and in bracket material. Classification Brackets can be classified according to:1. Width of bracket a. Mesiodistally narrow ex., Ribbon arch bracket, Begg bracket b. Mesiodistally wide ex., Edgewise bracket, Straight wire bracket 2. Slot of bracket a. Horizontal slot ex., Edgewise bracket b. Vertical slot ex., Begg bracket 3. Materials a. Metal – Stainless steel, Gold, Titanium, Nickel b. Plastics c. Ceramics d. Combination – Metal reinforced plastics, metal reinforced ceramics 4. Movement of tooth a. Tipping movement – Begg bracket b. Bodily movement - Straight wire bracket c. Tipping & Bodily movement – Combination bracket, Tip-Edge bracket 5. Ligation of bracket a. Conventional ligation – Edgewise bracket, Begg bracket b. Self-ligation- Edgelok bracket, SPEED bracket
JIADS VOL -1 Issue 3 July - September,2010 |25|
heavy wires are also accepted. The Siamese bracket quickly gained popularity for use on upper central incisors and on molar teeth. It comprises of the advantages of the Begg light wire technique and Straight Wire technique. the tube principle was abandoned for the bracket principle. tip. Its main advantage was its ability to effect most of the tooth rotation without the use of auxiliary eyelet ties. Each bracket has a vertical slot to accept rotating or uprighting springs. The round arch wire is loosely fitted and held in place by a lock pin or ligature tie wires. But. designed to be used with light wires.020”) with both the gingival and incisal ends chamfered to facilitate the insertion of auxiliaries from either direction. The bonding surface has a polycarbonate base with a slot to enable easy debonding and to avoid enamel fracture that occurs with ceramic brackets2. This in itself makes the bracket “universal” in its implementation. was the culmination of many years of effort and many different appliance designs attempting to place the teeth according to his “line of occlusion”. was the next step in the evolution of tooth alignment devices. This bracket is polycrystalline alumina and is manufactured by injection moulding.September. The specifications for torque. the edgewise appliance. He devised soldered gold eyelets to be placed in the bands. The original edgewise bracket as designed by Angle1 was a soft gold bracket with a 0. are the ceramic brackets. The gingival. William J. The wings are lingual to the archwire and therefore not visible. as such.022” size. It does not interfere with occlusogingival deflections of the JIADS VOL -1 Issue 3 July . The slot is rectangular (0. Thus these brackets had a vertical slot facing occlusally in contrast to the Begg bracket which faces gingivally. power pins and jigs for accurate direct bonding. The ribbon arch brackets designed by Angle were placed inverted by Begg3 with the slot facing gingivally. Various modification of edgewise brackets are: Single Width Bracket It was designed to overcome the problem of tooth rotation. Ceramaflex II – 256 Begg Brackets The most exciting addition to the Begg appliance component list. Lateral extensions of the bracket behind the arch wire provide maximum rotational control even when the tooth is tipped. He soldered auxiliary rotation arms that abutted against the bracket itself and thus offered a lever arm to deflect the archwire and rotate the tooth. Universal Bracket The name “universal”2 only connotes that the bracket is effective to move and control tooth movement in all planes. The base of the four-stage bracket is bevelled to reduce the possibility of friction or binding with the arch wire. These bracket types provide adequate mesiodistal width for optimal rotations. he determined that is necessary for each tooth to tip freely either mesially or distally-not in both directions. to be used in an orthodontic appliance. tipping and torque. Peter C. Modern Begg Bracket Dr. Twin Bracket The next development was the joining together of two edgewise brackets on a common base. In the ribbon arch appliance. TP Orthodontics Inc markets it as “Ceramaflex II – 256 Begg” brackets. Begg Bracket These are modified ribbon arch brackets. The face of the edgewise bracket has been changed to permit free crown tipping followed by controlled root uprighting. and in-out placement vary for each tooth.Evolution of Orthodontic Brackets Tamizharasi & Senthil Kumar Description of Brackets Ribbon Arch Bracket The ribbon arch appliance introduced in 1915. Lewis Bracket Lewis developed another approach to the problem of efficient tooth rotation.022” x 0. After many years another evolutionary step was the curving of the base of the twin bracket to confirm to the curvatures of the canines and premolar. Kesling designed the Tip Edge bracket5. but for stability purposes. The mesial and distal walls of the tube were removed. Edgewise Bracket Angle's final achievement. This is responsible for the free tipping and sliding of teeth during the initial stages of treatment. Tip Edge Bracket Dr. From his experiences with differential tooth movement for 30 years and a thesis written in 1968. It has two separate slots to receive single or multiple wires for the various tooth movements. which are narrow mesio-distally and carry a vertical slot usually of 0. It is truly a light wire bracket. or ribbon-arch slot is designed to permit maximum crown and root tipping movements and the edgewise slot is designed for precise final detailing. The bracket also has wings that enhance the wire action. apical movements are not possible without the use of auxiliary springs. It was actually the first bracket.2010 |26| . It was named after the originator of the idea Swain1.020” x 0.028” slot which was readily deformed by the forces of occlusion and by tying ligature wires to the bracket. Thompson introduced the Modern Begg4 Technique in the year 1981. because of the narrow bracket and round wire.
and offset and an analysis and treatment-planning chart with a step-by-step treatment JIADS VOL -1 Issue 3 July . 8. The Roth Set-up The Roth Set-up7 was introduced in the year 1976. Dr. in the year 1995. Partly programmed bracket contains 220 slot inclinations. Bennett & Mclaughlin Technique The authors Richard P McLaughlin & John C.017” wire. Andrews Prescription Dr. triple-control setup with rotational control. Swain Modification of The Roth Set-up Swain altered the prescription of the Andrews appliance to what he thought would allow the teeth to be placed in a slightly overcorrected position in all three planes of space but not so far overcorrected that the teeth would not “settle” into an idealized position1. Vertical Slot Lewis Bracket A refinement in the Lewis bracket has been the incorporation of a 0. second and third order bends has been reduced by producing a custom bracket for each tooth. Other Modifications: SVED MODIFICATION1 SINGLE EDGEWISE BRACKET WITH VERTICAL SLOT SINGLE EDGEWISE BRACKET WITH VERTICAL SLOT AND NARROW LIGATURE SLOT SINGLE EDGEWISE BRACKET WITH VERTICAL SLOT AND WIDE LIGATURE SLOT LEE-FISHER EDGEWISE BRACKET MODIFIED LEE-FISHER EDGEWISE BRACKET Preadjusted Edgewise Bracket In this bracket system the need for the first.Evolution of Orthodontic Brackets Tamizharasi & Senthil Kumar archwire. and the teeth are more easily moved into their proper positions with the 0. partially programmed and fully programmed appliances. torque. and values at -0. vertical slot 0. if double or triple buccal tubes on upper or lower molars are used ideal orthodontic occlusion can be achieved. James J. According to him. The next development in the Lewis rotation bracket was the curving of the base and wings of the bracket to conform to the canine and premolar teeth. The Vari-Simplex system is designed for 0. he feels patient comfort is improved. Lawrence F. Broussard Bracket It was developed by Garford Broussard1. Values at +0. Robert Murray Ricketts 1 1 introduced the Bioprogressive therapy in the year 1976.5mm and +1. introduced this technique. He altered the prescription of the Andrews appliance to allow the teeth to be placed in a slightly overcorrected position in all three planes. They produced a “Theoretical Bracket Placement Chart” by measuring the distance from the incisal or occlusal edge to the centre of the clinical crown. rectangular.020” x 0.0mm for smaller teeth. Wick Alexander8 described it in the year 1978. Bennett9 . These characteristics for each tooth are called the “appliance prescription” or “building treatment into the appliance”.5mm and -1. Non programmed brackets are without slot or base inclination. Charles J.018” bracket slots and 0. Vari-simplex Brackets The Vari-Simplex Discipline includes a specific bracket system used in case treatment. There are 3 combinations .standard progressive setup where torque is built into upper incisor and all 4 canines. Steiner Bracket This bracket incorporated flexible rotation arms which afforded a rotational effect. treatment time is decreased. His appliance was based on six keys to normal occlusion.September. 7. 6. His Vertical Tube Cuspid Bracket10 is very popular featuring an horizontal auxiliary tube. inclinations of slot and torque of the slot are used to minimize the wire bending for ideal archwire.022” brackets can also be used. 5.2010 |27| 2.020” vertical slot. The purpose of the Roth setup was to provide idealized tooth positions prior to appliance removal that would allow the teeth in most instances to settle in nonorthodontic normal's studied by Andrews. Burstone introduced this technique which uses the Medium Diamond Twin brackets of the Orthos prescription. .0mm were added for larger teeth. It works satisfactorily as long as the flexible arms do not take on a permanent deformation.046” which is formed when the bracket is welded onto the band material. Hilgers in the year 1987. It is a conventional bracket with a closed. fulltorque setup where torque built in lower molars and premolars. 1. Bioprogressive Technique Dr. 3. 4. Linear Dynamic System The linear dynamic System is a simplified version of the Bioprogressive11 therapy given by Dr. Though 0. 9. He divided the appliance as nonprogrammed. in which a combination of varying thickness of bracket base. Andrews6 introduced the Straight Wire Appliance to Orthodontic profession in 1970.018” slot.018” by 0. Fully programmed brackets have 220 base inclination. Segmental Arch Technique Dr. The Level Anchorage System It consists of a banded or bonded edgewise appliance with built-in tip. making possible the use of uprighting springs to correct axial inclinations if needed.
brittleness of the bracket and surface finish has been largely addressed in the second generation of ceramic brackets. Despite their advantage. It's one-piece construction requires no brazing layer. It was designed to provide the first differential stiffness bracket to accommodate the new. The maximum practical width of a wide bracket is about half the width of a tooth. The original 22-slot would have some JIADS VOL -1 Issue 3 July . Craig Andreiko12. More efforts are directed improving the strength of polycarbonate/ polymeric brackets by reinforcing the weak plastic matrix. as well as lingual root torque in upper and lower cuspids. differential-force superelastic wire. The magnet has at the present time the highest available coercivity and maximum energy product. 10. TP orthodontics has introduced the Nu-Edge bracket in the year 1997. higher-torque version of the Orthos appliance system. In the lingual bracket. Plastics were introduced in the late sixties and ceramics have been introduced in the mid eighties. Viazis designed the Bioefficient brackets17 in the year 1995. The wider the bracket on a tooth. The groove for lockpin insertion was set mesiodistally in the slot and an auxiliary groove was set in the occlusogingival direction to facilitate correction of the mesiodistal tipping of the teeth.September. glass or even with metal inserts. Kinya Fujita14 introduced the Mushroom arch wire appliance in the year 1979. It does not set until it's light cured. and thus it is solder and nickel-free. These types of brackets are reinforced with ceramic. The “ORTHOS” System Dr. Lingual Brackets Dr. Bioefficient Brackets Dr. The Bios System “Bios” is a light-wire. remained the most widely used material in the manufacture of orthodontic attachments. the opening of the slot was set on the occlusal surface of the teeth in order to facilitate the fitting of the wire.2010 |28| . “ Activa Brackets”. Bracket Materials gold. Recently. truly incited a worldwide movement away from pre-adjusted appliances based on 1960s metrology. Recently. and even narrower brackets have an advantage when teeth are malaligned. 15% to 25% cobalt. all other things being equal.. These triangular brackets are twin brackets with a single-slot type. a new material that contains a rare earth metal –samarium has been included in the magnet. The wider bracket reduced both the force needed to generate the moment and the contact angle..polyurethane. Shortened chair time and slightly less incisor proclination appear to be the significant advantages of self-ligating system16. and inadequate retention. and filler-reinforced brackets became available18. “Damon SL Brackets” . wider brackets also have disadvantage. Adhesive Precoated Brackets The orthodontic resources of United and the adhesive expertise of 3M have combined to create the first Adhesive Precoated metal brackets. The magnetic material that first employed clinically was a cast alloy consisting of 25% to 30% chromium. Dr. The possibility of puncture wounds from ligature ties is nil. The first orthodontic attachments were made of Since the introduction of Stainless steel it has Bracket Slot Good torque is possible with steel wires and 18mil edgewise brackets. corrosion. and is thus advantageous for space closure by sliding. Later. the easier it will be to generate the moments needed to bring roots together at extraction sites or to control mesiodistal position of roots in general. fiber-reinforced.Evolution of Orthodontic Brackets Tamizharasi & Senthil Kumar procedure for seven different extraction and non extraction choices. Bracket Width The wider the bracket. Polycarbonate brackets were described and tested by Newman in 1969. 11. and therefore the shorter the effective length of the archwire segments between supports. Self Ligating Brackets Self ligating brackets were introduced in the seventies with the Edgelok bracket. These brackets have the advantage of aesthetics and comfort. The most common used brackets are “Mobil-Lok brackets”. the smaller the interbracket span between adjacent teeth. enamel fracture on debonding. in 1987. Anthony D. “SPEED brackets15”. Jim Hilgers designed the Bios system13 to allow for earlier torque control with lighter wires. “Time Bracket” etc. distortion and tearing of the bracket –particularly from torsional forces. and 45% to 60% iron. Titanium bracket have solved the problems of nickel sensitivity. Ceramic brackets were first introduced in 1987 and it has found wide acceptance and still holds more promise. They have limited popularity because of clinical problems of staining – rendering them unaesthetic. “Insert bracket”. Magnetic brackets were introduced by Kawata et al19. It uses cobalt chromium alloy that is essentially nickel free. It differs from the Orthos prescription by virtue of its increased torque in upper incisors and in the mandibular posterior segment. applied computer-aided engineering technology to orthodontic appliance design in developing the Orthos System. the introduction of active and passive self-ligating brackets has presented a challenge to the speciality because of the novel ligation mode and the potential alterations in load and moment expression during mechanotherapy. The number of problems such as excessive bond strength. because the greater interbracket span gives more springiness.
Regarding bracket materials. A fundamental change would be in the abolition of bracket systems and their replacement with preprogrammed microchips driven by computers. and the control of PDL blood vessels and cells by pharmacological targeting. still metal brackets have more advantages than aesthetic brackets in reducing the friction during retraction and also facilitates easy debonding procedures. reduces the patient visits and enhances better patient co-operation. According to him. The advancement of the size. and improved resistance to degradation. The recent introduction of zirconia-based ceramics as a restorative dental material has generated considerable interest in the dental community. Periodic reviews are necessary for the orthodontist to update his knowledge as well as to decide a better treatment plan and provide better comfort zone to the patient. yet recycled brackets are still used to reduce the cost per case. NiTi alloys with springback and resistance to permanent deformation have overcome some of the alignment limitations of steel wires in 22 mil slot brackets. Such studies will help the practitioner to decide the bracket selection for his treatment plan. The wire size of the mesh as well as the size and topography of spot welds are also considered in bond strength. Today's favourite bases are die cut from laminates made of a fine mesh. The invention of self ligating brackets has shortened the treatment duration. Eliades T23 states that manufacturing techniques might be modified to include laserwelding methods and metal injection molding. et al. pressed under heat to a foil that can have various thickness.Evolution of Orthodontic Brackets Tamizharasi & Senthil Kumar advantage during space closure but would be a definite disadvantage when torque was later added. decreased water sorption. With the advent of aesthetic brackets and aesthetic archwires the field is becoming more refined day by day. The use of small.September. achieved by coating the bases with porous metal powder. The bracketless invisible aligner technique has been considered as a new developed orthodontic technique since its appearance during the period of late 1990s. while rectangular NiTi and Beta-Ti wires offer advantages over steel for the finishing phases of treatment and torque control17. Summary And Conclusion Orthodontia has attained unmeasurable goals in the past century. shape. Brackets can be recycled either by application of heat to burn off the adhesive or by using chemical solvents to strip off the adhesive. computer software and hardware technology. biomolecular methods of malocclusion correction and long-term stability. Coating of bonding agents on bracket bases also increases retention. Future survival of this profession will depend on a radically different specialist who will be educated with a postgraduate curriculum based on molecular biology and computer engineering24. Recycling Though there are still concerns about the possible increased risk of cross infection. According to Bai YX22 there have been many opportunities for further development and clinical application for this technique with the developments of material sciences. foil mesh bases. aesthetics and treatment results of each bracket. Discusssion Although Orthodontia started to function without the use of brackets. he describes that new plastic brackets might incorportate ceramic wings23. Today. The brackets are also silanated as a final step which creates higher additional bond strength due to chemical bonding of the bracket with the adhesive. JIADS VOL -1 Issue 3 July . the reduction in the curing time and change in light direction may increase the bond strength and reduce enamel fracture during debonding. But. it is necessary for the Orthodontist to keep in pace with rapid changing technology of Orthodontic brackets and materials to be a successful clinician. If only steel wires are to be used. Sims MR24 has viewed the future of brackets from a technical point. we are surprised to know that there was a period when Orthodontia was functioning without brackets. Further. material and technology of brackets of today is amazing. yet today it has become an integral part of it. rapid prototyping techniques. in the next millennium. Esthetic bracket research will involve the synthesis of high-crystallinity biomedical polymers with increased hardness and stiffness. Hence. According to Koutayas SO et al20. The most common bracket bases are perforated bases. Though various authors have predicted the future of brackets in their own ways yet at present tooth movements produced by bracket-archwire combination will be the ultimate method for years to come.. Heravi F21 states that in future. less noticeable. This article has only reviewed the evolution of brackets. the 18-mil slot system has advantage over the larger bracket size. Bracket Bases One of the most important factors in retention of an Orthodontic bracket is type of bracket base. The coating process increases mechanical retention by creating undercuts on the top and sides of the wire mesh. metal bases helps avoid gingival irritation. photoetched bases and integrated cast type bases. zirconia based orthodontic brackets can be technologically feasible. We suggest that many more review studies should come aiming at the biocompatibility. the genome revolution and knowledge of protein production and control could lead to the genetic correction of dentofacial anomalies and pain-free.2010 |29| . A still promising forward step is the micromechanical retention.
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