MBT™ Bracket Placement Technique
M c L a u g h l i n , B e n n e t t , T r e v i s i
MBT™ Bracket Placement Technique
Traditionally, it has been recom-
mended that pre-adjusted appliance
brackets be placed with the twin
bracket wings straddling, in a parallel
fashion, the vertical long axis of the
clinical crown, and that the center
of the bracket slot be placed on the
center of the clinical crown.1 Potential
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
Horizontal bracket placement errors. These can
normally be avoided with careful technique.
Horizontal errors
Brackets can be placed to the
mesial or distal of the vertical long
axis of the clinical crown, leading
to improper tooth rotation (fig. 1).
Elimination of such errors can be best
achieved by visualizing the vertical
long axis of the crown directly from
the facial surface, as well as from the
incisal or occlusal surface with a
mouth mirror. Some orthodontists
even consider drawing a line through
the vertical long axis of the clinical
crown for more accurate visualization.
2 F I G U R E
Axial or paralleling bracket placement errors. These
can normally be avoided with careful technique.
Axial or paralleling 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). Such
errors lead to improper crown tip
and can also be avoided by viewing
the crown directly from the facial
surface, as well as from the incisal
or occlusal surface. Such errors can
be eliminated by using the same
techniques described for the
elimination of horizontal errors.
3
Excess bonding agent beneath the bracket base
can cause thickness and rotational errors.

Thickness errors
Such errors can occur if excessive
adhesive is left underneath one
portion of the bracket base (fig. 3),
or if the contour of the tooth does
not correspond accurately to the
contour of the base of the bracket.
Such errors can cause improper
tooth torque or rotation, and can be
eliminated by pressing the bracket
against the tooth at placement, so
that excessive adhesive flows from
beneath the bracket, or by contouring
the bracket base to more accurately
fit the tooth surface.
F I G U R E 4 F I G U R E
Vertical errors in bracket placement are caused
by placing brackets gingival or incisal/occlusal
to the center of the clinical crown.
Vertical errors
Vertical bracket placement errors
occur when the bracket is placed
gingival or incisal/occlusal to the
center of the clinical crown (fig. 4).
Such errors lead to extrusion or
intrusion of teeth, as well as potential
torque and in/out errors.
The human eye is quite accurate
at bisecting and locating the center
of a given object such as a crown, (as
Andrews stated1). Therefore, brackets
can be placed accurately using direct
visualization on fully erupted and
anatomically normal teeth. However,
in the following clinical situations
(which occur quite frequently),
direct visualization is more difficult.
5 F I G U R E
It is difficult to visualize the center of the clinical
crown on partially erupted teeth, when treating
young patients.
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
Gingival Concerns
1. Partially erupted teeth. It is
difficult to locate the center of
the clinical crown on partially
erupted teeth (fig. 5) when treating
young patients. The apparent
clinical crown is foreshortened,
and the tendency is to place the
bracket too incisally or occlusally,
especially with bicuspids and
lower second molars.
2. Gingival inflammation.
Gingival inflammation (fig.6)
causes foreshortening, with the
tendency to place the bracket too
occlusally or incisally.
6
Gingival inflammation causes foreshortening,
effectively reducing the length of the clinical crowns.
Top: Healthy gingivae. Bottom: The same case with
inflamed gingivae in the upper right quadrant.
M c L a u g h l i n , B e n n e t t , T r e v i s i
F I G U R E 7
3. Teeth with palatally or lingually
displaced roots. With such teeth,
gingival tissue covers a greater
11mm portion of the clinical crown than
normal, producing a shorter
clinical crown. The tendency is
to place the bracket too incisally
10mm
or occlusally (fig. 7).
4. Teeth with facially displaced
Individual teeth with lingually displaced
roots. Such teeth tend to show a
roots can produce short clinical crowns.
lengthened clinical crown, creating
a tendency to place the bracket
F I G U R E 8
too gingivally (fig. 8). This is a
common occurrence with cuspids.
11mm
Incisal or Occlusal Concerns
1. Incisal or occlusal crown frac-
tures or tooth wear. With such
teeth (fig. 9) it is difficult to visualize
12mm the center of the clinical crown
since the apparent clinical crown
Individual teeth with facially displaced is foreshortened. Correction of this
roots can produce long clinical crowns.
problem can be made by either
restoring the crown to its appro-
F I G U R E 9 priate length, or by estimating
how long the crown was before
fracture or wear.
Incisal crown fractures or tooth wear
make it difficult to visualize the center
of the clinical crown.
2. Crowns with long tapered buccal
cusps. Occasionally a crown on a
tooth such as a cuspid or bicuspid
will show an unusually long and
tapered buccal cusp (fig. 10). If
the bracket is placed in the center
of the clinical crown, adjacent
marginal ridges will not be prop-
erly aligned. This situation can be
corrected by selectively reducing
the height of the cusp prior to
bracket placement.
Proportionally long or short clinical crowns
1. Proportionally long clinical
crowns. When individual clinical
crowns are proportionally longer
than the mean for the individual’s
dentition (frequently seen with
the upper central incisors), an
inherent esthetic and occlusal error
will be created if the brackets are
placed in the centers of the clinical
crowns. Esthetically, these crowns
will be too long, and functionally
they will create an interference
with the opposing dentition. In

this situation, it is necessary to
place brackets slightly incisal to
the center of the clinical crowns
of the oversize teeth. While this
adjustment may produce a minor
error in the torque relationship
and thickness relationship of these
teeth, the problem is normally
minimal, and if necessary must
be corrected in the finishing stages
of treatment with archwire bends.
2. Proportionally short clinical
crowns. When clinical crowns are
proportionally shorter than the
mean for the individual’s dentition
(sometimes seen with the upper
lateral incisors) (fig. 11), an
inherent esthetic and occlusal
error is also created if the brackets
are placed in the centers of the
clinical crowns. Esthetically, these
crowns will be too short, and
functionally they will be out
of contact with the opposing
dentition. In this situation, it is
necessary to place brackets slightly
gingival to the center of the clinical
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
crown. While this adjustment may F I G U R E 1 0
also produce a minor error in the
torque relationship and thickness
relationship of these teeth, the
Cuspids with tapered clinical crowns often do not
problem is normally minimal, and have adequate contact with the opposing teeth.
if necessary must be corrected in
the finishing stages of treatment
with archwire bends. 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, a study was carried out
to provide a method that could serve
as a supplement to the direct visual-
ization technique. This study was
published in May 1995 in the Journal
of Clinical Orthodontics.2 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. This in turn allowed for
more accurate vertical bracket
placement in the above clinical
situations. The bracket placement
chart is shown in Table 1.
Case with large (and disproportionately sized)
upper central incisors and small lateral incisors
M c L a u g h l i n , B e n n e t t , 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 U6 U5 U4 U3 U2 U1

2.0 4.0 5.0 5.5 6.0 5.5 6.0 +1.0mm

2.0 3.5 4.5 5.0 5.5 5.0 5.5 +0.5mm

2.0 3.0 4.0 4.5 5.0 4.5 5.0 Average

2.0 2.5 3.5 4.0 4.5 4.0 4.5 -0.5mm

2.0 2.0 3.0 3.5 4.0 3.5 4.0 -1.0mm

L7 L6 L5 L4 L3 L2 L1

3.5 3.5 4.5 5.0 5.5 5.0 5.0 +1.0mm

3.0 3.0 4.0 4.5 5.0 4.5 4.5 +0.5mm

2.5 2.5 3.5 4.0 4.5 4.0 4.0 Average

2.0 2.0 3.0 3.5 4.0 3.5 3.5 -0.5mm

2.0 2.0 2.5 3.0 3.5 3.0 3.0 -1.0mm

s Table 1. 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. These changes were based on evaluations of the American Board-Angle Society case
measurements and cases measured at the debanding appointment.
DISCUSSION
Use of the Bracket Placement
Chart (table 1) eliminates potential
gingival errors because measure-
ments are made from the occlusal or
incisal edge of the teeth. This alone is
a major advantage, 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. It also
eliminates the difficulty presented
with proportionally large or small
teeth within the dentition. When
these teeth are present, it is necessary
to place the bracket slightly off of the
center of the clinical crown in order
to avoid occlusal interferences, lack
of occlusal contact, and esthetic
height problems. The Bracket
Placement Chart allows for this
adjustment. The only potential
errors that cannot be avoided are
on crowns with incisal or occlusal
fractures or wear, or on crowns with
unusually long tapered facial cusps.
When these situations occur, an
appropriate millimeter adjustment
needs to be made to allow the crown
to be properly positioned.
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.
Step two
These figures are recorded,
divided in half and rounded to the
nearest .5 mm to obtain measure-
ments for the distance from the
incisal or occlusal surfaces to the
center of the clinical crowns.
Step three
The row on the bracket
placement chart that contains the
greatest number of recorded figures
is selected for bracket placement.
M c L a u g h l i n , B e n n e t t , T r e v i s i
A. Because of the possible presence
of proportionately large teeth (i.e.
upper central incisors) or small
teeth (i.e. 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.
B. As stated above, when crowns
show incisal or occlusal wear
or fracture, or excessively long
tapered cusps, an appropriate
millimeter adjustment must be
made to assure correct position
of these crowns.
Step four
At the time of banding and
bonding, 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.
Step five
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. The authors prefer to use the
bracket positioning instruments
from 3M Unitek.
A. For direct bonding procedures,
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.
With the placement of any
bracket on the lower arch, there is
always the potential for interferences
with the upper dentition. When this
situation occurs in the molar region,
it is generally due to lingually
inclined crowns which elevate the
position of the bracket on the buccal
surface. When this occurs the choices
are to allow the interference to occur
until crown uprighting occurs, to
place an upper anterior bite plate
and eliminate the interference,
to place the effected bracket more
gingivally and place a step bend to
avoid extrusion of the tooth, or to
place all brackets proportionately
more gingival on the lower arch.
When the interference occurs in the
incisor region, it is normally due to
the presence of a deep overbite. The
choices in this situation are to leave
brackets off of the lower incisors
until bite opening occurs, to allow
the interference to occur until bite
opening is achieved, or to place an
anterior bite plate until bite opening
occurs. The specific decision to be
made in each case is dependent on
the clinical situation.
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, with fewer cases
requiring bracket repositioning
due to vertical placement errors.
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.
 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. However in situations in
which there are gingival variations,
differences in tooth size within
the dentition, or incisal or occlusal
variations, this direct visualization
technique becomes more difficult.
Such situations do occur quite fre-
quently in an orthodontic practice.
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. Measure-
ment 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 reposi-
tioning due to incorrect visualization
of the center of the clinical crown.

2.0 –2.5 mm, REF. 900-836

3.0 –3.5 mm, REF. 900-837

4.0 –4.5 mm, REF. 900-838

5.0 –5.5 mm, REF. 900-839

3M Unitek Bracket Positioning Gauges are offered individually or as a kit of 4 instruments.

REFERENCES
1.Andrews, L.F.: Straight-Wire - The Concept and The Appliance. Los Angeles. Wells Company. 1989.

2.Mclaughlin, R. P. and Bennett, J. C.: “Bracket Placement with the Pre-adjusted Appliance”
Journal of Clinical Orthodontics May 1995; 29: 302-311.
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